Individual provider Active NPI

Jorge Sam, RN

  • Certified Registered Nurse Anesthetist
  • Voorhees, NJ
National Provider Identifier
1245724301
Registry record updated Jan 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
26NJ15024300 Issued in NJ
Practice address
136 Route 73 Ste a
Voorhees, NJ 08043-9598
Phone
(877) 388-2778
Fax
(856) 424-7529
NPI assigned
Jun 21, 2018
Last updated
Jan 24, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 26NR18057100 NJ
Certified Registered Nurse Anesthetist 367500000X 26NJ15024300 NJ Primary
Registered Nurse 163W00000X RN590397 PA

Addresses

Primary practice location

136 Route 73 Ste a
Voorhees, NJ 08043-9598

Mailing address

1 Diamond Hill Rd
Berkeley Heights, NJ 07922-2104
Phone (908) 273-4300

Other practice location 1

111 S 11th St
Philadelphia, PA 19107-4824
Phone (215) 955-6161

Other practice location 2

111 S 11th St
Philadelphia, PA 19107-4824
Phone (215) 955-6161

Other practice location 3

175 Madison Ave
Mount Holly, NJ 08060-2099
Phone (609) 914-6000

Other practice location 4

218 Sunset Rd Fl 2
Willingboro, NJ 08046-1110
Phone (609) 835-2900

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jsam261583@directvirtua.org
Direct Messaging Address jsam261583@directvirtua.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, DE, NJ3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20180919002755 PA Practitioner - Certified Registered Nurse Anesthetist (Crna) 7517218233 Reassigns benefits to 1 organization
I20240606003663 DE Practitioner - Certified Registered Nurse Anesthetist (Crna) 7517218233 Reassigns benefits to 1 organization
I20240904000168 NJ Practitioner - Certified Registered Nurse Anesthetist (Crna) 7517218233 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jefferson University PhysiciansGroup PAC ID 7911819180, 1,528 clinicians
Virtua Medical Group, PAGroup PAC ID 9830222397, 1,678 clinicians

Practice addresses (Care Compare)

111 S 11TH St
Suite 8490
Philadelphia, PA 19107-4824
Phone (215) 955-6161

175 Madison Ave
Mount Holly, NJ 08060-2038

3242 Route 206
Bordentown, NJ 08505-4517

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse, Registered Nurse

State licenses

LicenseStateTypeSpecialty
RN590397PAMDRegistered Nurse
26NJ15024300NJMDCertified Registered Nurse Anesthetist
26NR18057100NJMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Medical Group PA CurrentSince Jul 1, 2024 Accepting new patients
Anesthesia Services PA CurrentSince May 10, 2024 Accepting new patients
Jefferson University Physicians CurrentSince Aug 28, 2018 Accepting new patients
Virtua Medical Group, PA Nurse Anesthetist, Certified Registered Current Accepting new patients
Virtua Medical Group, PA CurrentSince Nov 18, 2024 Accepting new patients
Virtua Medical Group, PA CurrentSince Nov 18, 2024 Accepting new patients
Summit Medical Group PA CurrentSince Jul 1, 2024 Accepting new patients
New Jersey Urology LLC PastSince Aug 11, 2024 Accepting new patients

Locations

2600 Glasgow Ave
Ste 226
Newark, DE 19702
Phone (302) 836-3539

4755 Ogletown Stanton Rd
Newark, DE 19718
Phone (302) 733-1700

1 Diamond Hill Rd
Berkeley Heights, NJ 07922
Phone (908) 277-8868

3242 Route 206
Ste 2
Bordentown, NJ 08505
Phone (609) 298-4340

175 Madison Ave
Mount Holly, NJ 08060
Phone (609) 261-1660

150 Floral Ave
New Providence, NJ 07974
Phone (908) 588-3890

111 S 11th St
Philadelphia, PA 19107
Phone (215) 955-6161

111 S 11th St
Ste 8490
Philadelphia, PA 19107
Phone (215) 955-6161

900 Walnut St
Fl 2
Philadelphia, PA 19107
Phone (215) 955-1234

925 Chestnut St
Fl 6
Philadelphia, PA 19107
Phone (215) 955-6760

Organizations & group practices 8

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 1

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": "1529539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737676800000",
    "number": "1245724301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 DIAMOND HILL RD",
            "city": "BERKELEY HEIGHTS",
            "state": "NJ",
            "postal_code": "079222104",
            "telephone_number": "908-273-4300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136 ROUTE 73 STE A",
            "city": "VOORHEES",
            "state": "NJ",
            "postal_code": "080439598",
            "telephone_number": "877-388-2778",
            "fax_number": "856-424-7529"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 S 11th St",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191074824",
            "country_code": "US",
            "telephone_number": "215-955-6161",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "111 S 11th St",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191074824",
            "country_code": "US",
            "telephone_number": "215-955-6161",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "175 Madison Ave",
            "address_purpose": "LOCATION",
            "city": "Mount Holly",
            "state": "NJ",
            "postal_code": "080602099",
            "country_code": "US",
            "telephone_number": "609-914-6000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "218 Sunset Rd Fl 2",
            "address_purpose": "LOCATION",
            "city": "Willingboro",
            "state": "NJ",
            "postal_code": "080461110",
            "country_code": "US",
            "telephone_number": "609-835-2900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAM",
        "first_name": "JORGE",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-21",
        "last_updated": "2025-01-24",
        "certification_date": "2025-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NJ",
            "license": "26NR18057100",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NJ",
            "license": "26NJ15024300",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "PA",
            "license": "RN590397",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jsam261583@directvirtua.org",
            "affiliation": "N",
            "address_1": "175 Madison Ave",
            "city": "Mount Holly",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080602099",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jsam261583@directvirtua.org",
            "affiliation": "N",
            "address_1": "218 Sunset Rd Fl 2",
            "city": "Willingboro",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "080461110",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Voorhees, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.