Samuel Allado Bangug, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

235683 Issued in NY

Practice address

17013 Hillside Ave
Jamaica, NY 11432-4546

Phone

(718) 657-2706

Fax

(718) 657-2420

NPI assigned

Oct 12, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Networks

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

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/CIAIAA/Endpoint/CIAIAA

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.

• Reverb Physical Therapy PC

  • Physical Therapist
  • Jamaica, NY
  • NPI 1073717542
  NPD (past)

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1255420345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "164 ASTER DR",
            "city": "NEW HYDE PARK",
            "state": "NY",
            "postal_code": "110402134",
            "telephone_number": "718-657-2706",
            "fax_number": "718-657-2420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17013 HILLSIDE AVE",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114324546",
            "telephone_number": "718-657-2706",
            "fax_number": "718-657-2420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANGUG",
        "first_name": "SAMUEL",
        "middle_name": "ALLADO",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "235683",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02194883",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Leslie Raphaelle Balogun
• Edward Balsam, MA
• Jessica Baltman, PHD
• Banani Road 11 LLC
• Bangladesh American Association for Rehabilitation in New York (Baarny
• Olubukunola B Banjoko, RN
• Annecia Banks
• Gabrielle Banks, LMSW
• Alfred Clayton Bannerman, M.D.
• Qudsia Banu, M.D.

• Pediatrics Physician in Jamaica, NY
• Providers in Jamaica, NY by specialty
• Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.