NPIMap

Individual provider Active NPI

Samir Patel, MD

  • Internal Medicine Physician
  • Warren, NJ
National Provider Identifier
1407954548
Registry record updated Mar 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MA07446700 Issued in NJ
Practice address
266 King George Rd
Suite D
Warren, NJ 07059-5120
Phone
(908) 626-1776
Fax
(908) 626-0776
NPI assigned
Sep 20, 2006
Last updated
Mar 9, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MA07446700 NJ Primary

Addresses

Primary practice location

266 King George Rd
Suite D
Warren, NJ 07059-5120

Mailing address

PO Box 118
Berkeley Heights, NJ 07922-0118
Phone (908) 626-1776

Other identifiers 3

IdentifierTypeStateIssuer
60001670OtherHORIZON NJ HEALTH
25321MedicaidNJ
25512OtherUNIVERSITY HEALTH PLAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051006000394 NJ Practitioner - Internal Medicine 0042235319 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

266 King George Rd
Suite D
Warren, NJ 07059-5120
Phone (908) 626-1776

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MA07446700NJMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Berkeley Internal Medicine Internal Medicine CurrentSince Jan 1, 2009 Accepting new patients
Hospitalist Associates Inc Internal Medicine Past Accepting new patients

Locations

266 King George Rd
Ste D
Warren, NJ 07059
Phone (732) 662-3050

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Spring Grove Rehabilitation and Healthcare CenterNew Providence, NJ, CCN 315005 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Oct 4, 2018
Oct 4, 2018

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Spring Grove Operator LLC

    dba Spring Grove Rehabilitation and Healthcare Center

    • Skilled Nursing Facility
    • New Providence, NJ
    • NPI 1487151940

    Adp of the SNF, Operational/Managerial Control

    CMS ownership

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489017600000",
    "number": "1407954548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 118",
            "city": "BERKELEY HEIGHTS",
            "state": "NJ",
            "postal_code": "079220118",
            "telephone_number": "908-626-1776",
            "fax_number": "908-626-0776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "266 KING GEORGE RD",
            "address_2": "SUITE D",
            "city": "WARREN",
            "state": "NJ",
            "postal_code": "070595120",
            "telephone_number": "908-626-1776",
            "fax_number": "908-626-0776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "SAMIR",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2017-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "MA07446700",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HORIZON NJ HEALTH",
            "identifier": "60001670",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "25321",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERSITY HEALTH PLAN",
            "identifier": "25512",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, NJ

Sources for this page

Verify at the official NPI Registry.