Active NPI
Jodi Sam
- Home Health Aide
- Youngstown, OH
National Provider Identifier
1407698137
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Aide
- License
- SR899934
- Practice address
- 202 S Maryland Ave
Youngstown, OH 44509-2812 - Phone
- (330) 774-0577
- NPI assigned
- Jun 12, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Aide | 374U00000X | SR899934 | OH | Primary |
| Home Health Aide | 374U00000X |
Addresses
Primary practice location
202 S Maryland Ave
Youngstown, OH 44509-2812
Mailing address
202 S Maryland Ave
Youngstown, OH 44509-2812
Phone (330) 774-0577
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SR899934 | OH | MD | Home Health Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1718150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718150400000",
"number": "1407698137",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "202 S MARYLAND AVE",
"city": "YOUNGSTOWN",
"state": "OH",
"postal_code": "445092812",
"telephone_number": "330-774-0577"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "202 S MARYLAND AVE",
"city": "YOUNGSTOWN",
"state": "OH",
"postal_code": "445092812",
"telephone_number": "330-774-0577"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAM",
"first_name": "JODI",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-06-12",
"last_updated": "2024-06-12",
"certification_date": "2024-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "374U00000X",
"taxonomy_group": "",
"desc": "Home Health Aide",
"state": "OH",
"license": "SR899934",
"primary": true
},
{
"code": "374U00000X",
"taxonomy_group": "",
"desc": "Home Health Aide",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Youngstown, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.