Samuel Eli Peckham, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

6659 Issued in CT

Practice address

47 Town St
Norwich, CT 06360-2323

Phone

(860) 892-7042

NPI assigned

Jan 16, 2007

Last updated

Sep 16, 2016By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in CT

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, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Northeast Medical Group IncGroup PAC ID 1254233836, 1,357 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Yale New Haven Health - Health at Home Southeast Home health agency, Waterford, CT, CCN 077015
• Lawrence & Memorial Hospital Hospital, New London, CT, CCN 070007
• Yale-New Haven Hospital Hospital, New Haven, CT, CCN 070022
• Westerly Hospital Hospital, Westerly, RI, CCN 410013

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as apm

Quality

86.54

Promoting interoperability

99.98

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: speckham465601@direct.ynhh.org

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.

• Northeast Medical Group, Inc.

  • Internal Medicine Physician
  • Bridgeport, CT
  • NPI 1043278351
  Medicare reassignment Care Compare group NPD

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

• Lawrence and Memorial Hospital, Inc.

  dba Lawrence and Memorial Hospital

  • General Acute Care Hospital
  • New London, CT
  • NPI 1073530879
  Care Compare affiliation
• Lawrence and Memorial Hospital, Inc.

  dba Lawrence and Memorial Hospital

  • General Acute Care Hospital
  • New London, CT
  • NPI 1700092459
  Care Compare affiliation
• Visiting Nurse Association of Southeastern Connecticut

  • Home Health Agency
  • Waterford, CT
  • NPI 1265490940
  Care Compare affiliation
• Yale New Haven Hospital

  • General Acute Care Hospital
  • New Haven, CT
  • NPI 1336139500
  Care Compare affiliation
• Yale New Haven Hospital

  • General Acute Care Hospital
  • New Haven, CT
  • NPI 1578778726
  Care Compare affiliation
• LMW Healthcare Inc.

  dba Westerly Hospital

  • General Acute Care Hospital
  • Westerly, RI
  • NPI 1447595368
  Care Compare affiliation

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473984000000",
    "number": "1447301163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 TOWN ST",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063602323",
            "telephone_number": "860-892-7042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47 TOWN ST",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063602323",
            "telephone_number": "860-892-7042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PECKHAM",
        "first_name": "SAMUEL",
        "middle_name": "ELI",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-16",
        "last_updated": "2016-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "6659",
            "primary": true
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "CT",
            "license": "239",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Renee Pawluk, DPT
• Mark Anthony Peake
• Caleb Paul Peck, PSYD
• Julie Michele Peck, MBBCHB
• Elizabeth Nicole Peckham, NP-C
• Pediatric Services of America, LLC (Aveanna Healthcare)
• Andrea Pedraza-Jennings, LCSW
• Carol Lee Pennell, RNC, IBCLC,CCE
• David Allen Percival, D.M.D.
• Kelsey Lynn Perez

• Family Nurse Practitioner in Norwich, CT
• Providers in Norwich, CT by specialty
• Family Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2016; 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.