Samuel J Mutch

Primary specialty

DentistTaxonomy code 122300000X

License

18508 Issued in NJ

Practice address

308 Tuckerton Road
Medford, NJ 08055

Phone

(609) 654-2454

Fax

(609) 654-6568

NPI assigned

Jan 10, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 1, 2019 through Apr 1, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Medford Family Dental Care PA

  • Dentist
  • Medford, NJ
  • NPI 1528076320
  NPD (past)

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1467501221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 TUCKERTON ROAD",
            "city": "MEDFORD",
            "state": "NJ",
            "postal_code": "08055",
            "telephone_number": "609-654-2454",
            "fax_number": "609-654-6568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 TUCKERTON ROAD",
            "city": "MEDFORD",
            "state": "NJ",
            "postal_code": "08055",
            "telephone_number": "609-654-2454",
            "fax_number": "609-654-6568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUTCH",
        "first_name": "SAMUEL",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": "18508",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7585306",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melanie Anne Mouhtis, FNP-C
• Stephanie Mroz, MS, LAT, ATC
• Francis Raymond Murphy, M.D.
• Suzanne Murphy, L. AC.
• Terri Lee Murphy, D.O.
• Kim Susan Nagle, D.C.
• Krista Nash, BSW
• Martina Nash
• Felicia R Neubauer, LCSW
• New Jersey CVS Pharmacy LLC

• Dentist in Medford, NJ
• Providers in Medford, NJ by specialty
• Dentist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.