Samuel S Wilburn, DNP, AGNP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

SP022592 Issued in PA

Practice address

1348 Bainbridge St
Philadelphia, PA 19147-1810

Phone

(215) 563-0657

NPI assigned

Aug 4, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in PA

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

Specialty

Nurse Practitioner

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/2819/brand/1/csg/1/fhir/r4
• Direct secure messaging: nancy.brisbon.1@2819.direct.athenahealth.com

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.

• Mazzoni Center

  • Family Medicine Physician
  • Philadelphia, PA
  • NPI 1477631307
  Medicare reassignment NPD
• Mazzoni Center

  • Social Worker
  • Philadelphia, PA
  • NPI 1225188428
  NPD
• Jefferson University Physicians

  dba Jefferson GI

  • Gastroenterology Physician
  • Phila, PA
  • NPI 1205898723
  NPD (past)

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

{
    "created_epoch": "1596499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701648000000",
    "number": "1396355327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1348 BAINBRIDGE ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191471810",
            "telephone_number": "215-563-0657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1348 BAINBRIDGE ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191471810",
            "telephone_number": "215-563-0657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILBURN",
        "first_name": "SAMUEL",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "DNP, AGNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-08-04",
        "last_updated": "2023-12-04",
        "certification_date": "2023-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "309784",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "PA",
            "license": "SP022592",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PENNSYLVANIA BOARD OF NURSING",
            "identifier": "SP022592",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEW YORK STATE DEPARTMENT OF EDUCATION",
            "identifier": "309784",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "nancy.brisbon.1@2819.direct.athenahealth.com",
            "affiliation": "Y",
            "endpointDescription": "direct messaging",
            "affiliationName": "Mazzoni Center",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "fax",
            "address_1": "1348 Bainbridge St",
            "city": "Philadelphia",
            "state": "PA",
            "country_code": "US",
            "postal_code": "191471810",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Alyse Cecelia Wilber, MSN, RN, CRNP, CPNP-
• Spencer Wilbert, DPT
• Steven C Wilbraham, MD
• Wilbur W Oaks MD & Associates PC
• Daniel Wilbur
• Mary Lynn Wilby, MSN, CRNP
• Marissa B Wilck, MD
• Paula Wilcox-Pendleton, FNP-C
• Cammie Wilcox
• Eric L Wilcox

• Adult Health Nurse Practitioner in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Adult Health Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2023; 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.