Individual provider Active NPI

Samantha Hussain, PA

  • Medical Physician Assistant
  • Elmhurst, NY
National Provider Identifier
1235774811
Registry record updated Nov 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
024342 Issued in NY
Practice address
4012 80TH St
Elmhurst, NY 11373-1234
Phone
(718) 886-9000
Fax
(718) 961-0666
NPI assigned
Nov 7, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 7, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 024342 NY Primary

Addresses

Primary practice location

4012 80TH St
Elmhurst, NY 11373-1234

Mailing address

4012 80TH St
Elmhurst, NY 11373-1234
Phone (718) 886-9000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20191122001119 NY Practitioner - Physician Assistant 0547692964 Reassigns benefits to 1 organization
I20260210000329 NJ Practitioner - Physician Assistant 0547692964 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Metro Dermatology of Ny,P.C.Group PAC ID 3779761705, 18 clinicians

Practice addresses (Care Compare)

4012 80TH St
Elmhurst, NY 11373-1234
Phone (718) 886-9000

41 -61 Kissena Blvd
5A
Flushing, NY 11355-3105

4161 Kissena Blvd
Suite 5a
Flushing, NY 11355-3105
Phone (718) 886-9000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Metro Dermatology of NJ,PA CurrentSince Jan 1, 2026 Accepting new patients

Locations

2175 Lemoine Ave
Fl 6
Fort Lee, NJ 07024
Phone (201) 585-4612

220 E 161st St
Bronx, NY 10451
Phone (718) 537-5000

4012 80th St
Elmhurst, NY 11373
Phone (718) 426-9595

Networks

  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H1722

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": "1573084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573084800000",
    "number": "1235774811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4012 80TH ST",
            "city": "ELMHURST",
            "state": "NY",
            "postal_code": "113731234",
            "telephone_number": "718-886-9000",
            "fax_number": "718-961-0666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4012 80TH ST",
            "city": "ELMHURST",
            "state": "NY",
            "postal_code": "113731234",
            "telephone_number": "718-886-9000",
            "fax_number": "718-961-0666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUSSAIN",
        "first_name": "SAMANTHA",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-11-07",
        "last_updated": "2019-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "024342",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elmhurst, NY

Sources for this page

Verify at the official NPI Registry.