Individual provider Active NPI

Samantha Bussanich, PA-C

  • Physician Assistant
  • Manahawkin, NJ
National Provider Identifier
1265808018
Registry record updated May 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
25MP00599300 Issued in NJ
Practice address
1140 Route 72 W
Manahawkin, NJ 08050-2412
Phone
(609) 597-6011
NPI assigned
Aug 17, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA031169 DC
Physician Assistant 363A00000X 25MP00599300 NJ Primary

Addresses

Primary practice location

1140 Route 72 W
Manahawkin, NJ 08050-2412

Mailing address

331 Newman Springs Rd
BLDG 2, Ste 220
Red Bank, NJ 07701-5688

Other practice location 1

900 23rd St NW
Washington, DC 20037-2342
Phone (202) 715-4000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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 1

Enrollment IDStateProvider typePAC IDDetails
I20250508002752 NJ Practitioner - Physician Assistant 6507168002 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MP00599300NJMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Hackensack Meridian Health Medical Group - Specialty Care PC CurrentSince Mar 3, 2025 Accepting new patients

Locations

30 Prospect Ave
Hackensack, NJ 07601
Phone (201) 488-0066

1944 State Route 33
Neptune, NJ 07753
Phone (732) 776-3787

1140 Route 72 W
Stafford Township, NJ 08050
Phone (609) 978-2194

Interoperability endpoints

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

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": "1439769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746144000000",
    "number": "1265808018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "331 NEWMAN SPRINGS RD",
            "address_2": "BLDG 2, STE 220",
            "city": "RED BANK",
            "state": "NJ",
            "postal_code": "077015688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 ROUTE 72 W",
            "city": "MANAHAWKIN",
            "state": "NJ",
            "postal_code": "080502412",
            "telephone_number": "609-597-6011"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "900 23rd St NW",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "DC",
            "postal_code": "200372342",
            "country_code": "US",
            "telephone_number": "202-715-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUSSANICH",
        "first_name": "SAMANTHA",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-17",
        "last_updated": "2025-05-02",
        "certification_date": "2025-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "DC",
            "license": "PA031169",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00599300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manahawkin, NJ

Sources for this page

Verify at the official NPI Registry.