Individual provider Active NPI

Stephanie Lynn Samuels, M.D.

  • Pediatric Endocrinology Physician
  • New Haven, CT
National Provider Identifier
1194084541
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Endocrinology PhysicianTaxonomy code 2080P0205X
License
064059 Issued in CT
Practice address
1 Park St
New Haven, CT 06504-8901
Phone
(617) 548-9759
NPI assigned
May 4, 2012
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Endocrinology Physician 2080P0205X MT208972 PA
Pediatric Endocrinology Physician 2080P0205X 064059 CT Primary

Addresses

Primary practice location

1 Park St
New Haven, CT 06504-8901

Mailing address

34TH and Civic Center Boulevard
The Children'S Hospital of Philadelphia
Philadelphia, PA 19104
Phone (215) 590-3174

Other practice location 1

34th and Civic Center Boulevard
The Children's Hospital of Philadelphia
Philadelphia, PA 19104
Phone (215) 590-3174

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190910002338 CT Practitioner - Pediatric Medicine 9436488806 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
064059CTMDPediatric Endocrinology Physician
MT208972PAMDPediatric Endocrinology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Yale University CurrentSince Aug 5, 2019 Accepting new patients
Yale University CurrentSince Aug 5, 2019 Accepting new patients

Locations

800 Howard Ave
New Haven, CT 06519
Phone (203) 785-2140

300 George St
Fl 6
New Haven, CT 06511
Phone (203) 785-6610

1 Park St
North Haven, CT 06504
Phone (203) 785-4643

Interoperability endpoints

  • Direct secure messaging: ssamuels43816@direct.ynhh.org

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1336089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1194084541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34TH AND CIVIC CENTER BOULEVARD",
            "address_2": "THE CHILDREN'S HOSPITAL OF PHILADELPHIA",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19104",
            "telephone_number": "215-590-3174",
            "fax_number": "215-590-3053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 PARK ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065048901",
            "telephone_number": "617-548-9759"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "34th and Civic Center Boulevard",
            "address_2": "The Children's Hospital of Philadelphia",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "19104",
            "country_code": "US",
            "telephone_number": "215-590-3174",
            "fax_number": "215-590-3053",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAMUELS",
        "first_name": "STEPHANIE",
        "middle_name": "LYNN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-05-04",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0205X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Endocrinology",
            "state": "PA",
            "license": "MT208972",
            "primary": false
        },
        {
            "code": "2080P0205X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Endocrinology",
            "state": "CT",
            "license": "064059",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Haven, CT

Sources for this page

Verify at the official NPI Registry.