NPIMap

Individual provider Active NPI

Samuel J. Goldman, DO

  • Geriatric Medicine (Internal Medicine) Physician
  • Manchester, NH
National Provider Identifier
1225019169
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
11562 Issued in NH
Practice address
138 Webster St
Manchester, NH 03104-2512
Phone
(603) 663-7030
Fax
(603) 663-7039
NPI assigned
Nov 8, 2005
Last updated
Jul 9, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 11562 NH Primary

Addresses

Primary practice location

138 Webster St
Manchester, NH 03104-2512

Mailing address

138 Webster St
Manchester, NH 03104-2512
Phone (603) 663-7030

Other identifiers 8

IdentifierTypeStateIssuer
011562OtherNHTUFTS PIN
2864160OtherNHAETNA PIN
30222124MedicaidNH
579605OtherNHCIGNA PIN
0406289OtherNHUHC PIN
692523OtherNHHPHC PIN
O4YP03808NH01OtherNHANTHEM ACES PIN
H60241OtherNHANTHEM REFERRING UPIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040811000414 NH Practitioner - Geriatric MedicinePractitioner - Internal Medicine 3274505177 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Geriatric MedicineAlso: Internal Medicine
Education
Nova Southeastern College of Osteo Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Elliot Physicians NetworkGroup PAC ID 6406743988, 78 clinicians

Practice addresses (Care Compare)

138 Webster St
Manchester, NH 03104-2512
Phone (603) 663-7030

275 Mammoth Rd
Manchester, NH 03109-4133

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Elliot Physicians Network Geriatric Medicine CurrentSince Jul 1, 2002 Accepting new patients
Bedford Hills SNF Opco LLC Past Accepting new patients
Elliot Professional Services Past Accepting new patients
Harborside New Hampshire Limited Partnership Past Accepting new patients
Courville at Manchester LLC Past Accepting new patients
Harborside New Hampshire Limited Partnership PastSince Mar 1, 2024 Accepting new patients

Locations

1 Elliot Way
Manchester, NH 03103
Phone (603) 663-2271

138 Webster St
Manchester, NH 03104
Phone (603) 645-5977

275 Mammoth Rd
Manchester, NH 03109
Phone (603) 663-8300

275 Mammoth Rd
Ste 1
Manchester, NH 03109
Phone (603) 663-3222

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Courville at Manchester LLCManchester, NH, CCN 305057 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Dec 1, 2023
Dec 1, 2023

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 6

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

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1131408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1225019169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "138 WEBSTER ST",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031042512",
            "telephone_number": "603-663-7030",
            "fax_number": "603-663-7039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "138 WEBSTER ST",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031042512",
            "telephone_number": "603-663-7030",
            "fax_number": "603-663-7039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDMAN",
        "first_name": "SAMUEL",
        "middle_name": "J.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-08",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NH",
            "license": "11562",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS PIN",
            "identifier": "011562",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PIN",
            "identifier": "2864160",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30222124",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA PIN",
            "identifier": "579605",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC PIN",
            "identifier": "0406289",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HPHC PIN",
            "identifier": "692523",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM ACES PIN",
            "identifier": "O4YP03808NH01",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM REFERRING UPIN",
            "identifier": "H60241",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, NH

Sources for this page

Verify at the official NPI Registry.