Jennifer Lee Samuels, RN, MSN, CPNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

95075527 Issued in CA

Practice address

4650 W Sunset Blvd
Los Angeles, CA 90027-6062

Phone

(323) 361-5162

Fax

(323) 361-3717

NPI assigned

Oct 18, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jennifer Lee Shaffer Former name

Medicare fee-for-service enrollment

Enrolled in AZ, CA2 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

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Pediatric Nurse Practitioner, Master of Science - Nursing, Nurse Practitioner, Registered Nurse

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Children's Hospital Los Angeles Medical Group, Inc.

  • Multi-Specialty Clinic/Center
  • Los Angeles, CA
  • NPI 1265530653
  Medicare reassignment NPD
• Emergency Medicine Specialists of Orange County

  • Emergency Medicine Physician
  • Orange, CA
  • NPI 1740214733
  Medicare reassignment NPD
• Scottsdale Physicians Group PLC

  • Internal Medicine Physician
  • Scottsdale, AZ
  • NPI 1689799579
  Medicare reassignment NPD
• United Telehealth Corp

  • Internal Medicine Physician
  • Scottsdale, AZ
  • NPI 1760036966
  Medicare reassignment NPD
• Allkids Urgent Care, LLC

  • Urgent Care Clinic/Center
  • Mesa, AZ
  • NPI 1811098221
  NPD (past)
• Phoenix Children's Hospital

  dba Phoenix Children's Medical Group

  • Pediatrics Physician
  • Phoenix, AZ
  • NPI 1922112044
  NPD (past)

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

{
    "created_epoch": "1192665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1265621866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7975 N HAYDEN RD",
            "address_2": "STE D354",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852583243",
            "telephone_number": "323-361-3550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4650 W SUNSET BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900276062",
            "telephone_number": "323-361-5162",
            "fax_number": "323-361-3717"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1430 N Cooper Rd",
            "address_2": "Suite 101",
            "address_purpose": "LOCATION",
            "city": "Gilbert",
            "state": "AZ",
            "postal_code": "852331242",
            "country_code": "US",
            "telephone_number": "480-633-1111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAMUELS",
        "first_name": "JENNIFER",
        "middle_name": "LEE",
        "name_prefix": "Mrs.",
        "credential": "RN, MSN, CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-18",
        "last_updated": "2022-07-21",
        "certification_date": "2021-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CA",
            "license": "95075527",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "95075527",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "SHAFFER",
            "middle_name": "LEE",
            "credential": "RN, MSN, CPNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Momona Woldemicael Samuel
• Scott Samuel
• Gabrielle B Samuels
• Howard Samuels
• Jasmine Joy Samuels
• Patricia C Samuels, MD
• Rachel Samuels, LMFT
• Rebecca Samuels
• Russell Samuels
• Stephanie Samuels, P.A.

• Pediatric Nurse Practitioner in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Pediatric Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.