Dmitry V Samsonov, MD

Primary specialty

Pediatric Nephrology PhysicianTaxonomy code 2080P0210X

License

269800 Issued in NY

Practice address

19 Bradhurst Ave
Ste 1400
Hawthorne, NY 10532-2140

Phone

(914) 493-7583

Fax

(914) 594-4011

NPI assigned

Nov 11, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

NephrologyAlso: Pediatric Medicine

Education

Other, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Boston Children'S Health Physicians LLPGroup PAC ID 8325937014, 80 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

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

Interoperability endpoints

• Direct secure messaging: dmitry.samsonov.p1@direct.cwpw.nextgenshare.com
• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Boston Children'S Health Physicians, LLP

  • Pediatrics Physician
  • Hawthorne, NY
  • NPI 1467454967
  Medicare reassignment Care Compare group NPD
• Metropolitan Medical Practice Plan PC

  • General Practice Physician
  • New York, NY
  • NPI 1306138383
  Medicare reassignment NPD
• Physician Affiliate Group of New York PC

  • Registered Dietitian
  • New York, NY
  • NPI 1013375526
  Medicare reassignment NPD
• Boston Childrens Health Physicians LLP

  • Clinical Medical Laboratory
  • Sleepy Hollow, NY
  • NPI 1588651079
  NPD

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

{
    "created_epoch": "1226361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374537600000",
    "number": "1356595862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1020",
            "city": "HAWTHORNE",
            "state": "NY",
            "postal_code": "105327507",
            "telephone_number": "914-493-7583",
            "fax_number": "914-594-4011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 BRADHURST AVE",
            "address_2": "STE 1400",
            "city": "HAWTHORNE",
            "state": "NY",
            "postal_code": "105322140",
            "telephone_number": "914-493-7583",
            "fax_number": "914-594-4011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMSONOV",
        "first_name": "DMITRY",
        "middle_name": "V",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-11-11",
        "last_updated": "2013-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0210X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Nephrology",
            "state": "NY",
            "license": "003556",
            "primary": false
        },
        {
            "code": "2080P0210X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Nephrology",
            "state": "NY",
            "license": "269800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03266039",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Malka Rubin
• Patricia Russell, RD, CDN
• Susan Eleanora Russo, RDN, CDN
• Ann-Marie Sabrsula
• Ramandeep Sahni, MD
• Claudio Sandoval, MD
• Brittany Sanford, MD
• Elisa Sangas, MS, BCBA, LBA-NY
• Nicolette Santoro, PA-C
• Rachel Santos, D.O.

• Pediatric Nephrology Physician in Hawthorne, NY
• Providers in Hawthorne, NY by specialty
• Pediatric Nephrology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2013; 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.
• 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.