Individual provider Active NPI

Samantha Ryllo, PA

  • Physician Assistant
  • Livingston, NJ
National Provider Identifier
1477230308
Registry record updated Oct 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
25MP00876300 Issued in NJ
Practice address
200 S Orange Ave Ste 102
Livingston, NJ 07039-5817
Phone
(973) 322-7020
NPI assigned
Jul 3, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 23, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 030278 NY
Physician Assistant 363A00000X 25MP00876300 NJ Primary

Addresses

Primary practice location

200 S Orange Ave Ste 102
Livingston, NJ 07039-5817

Mailing address

379 Campus Dr FL 4
Somerset, NJ 08873-1161

Other practice location 1

1901 1st Ave
New York, NY 10029-7491
Phone (212) 423-6262

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NJ2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20231030002686 NY Practitioner - Physician Assistant 4385090109 Reassigns benefits to 2 organizations
I20241202001874 NJ Practitioner - Physician Assistant 4385090109 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Barnabas Health Medical Group PCGroup PAC ID 9537316955, 1,027 clinicians

Practice addresses (Care Compare)

1 Robert Wood Johnson PL
New Brunswick, NJ 08901-1928
Phone (732) 828-3000

Hospital & facility affiliations

  • Cooperman Barnabas Medical Center Hospital, Livingston, NJ, CCN 310076

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
25MP00876300NJMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Barnabas Health Medical Group PC CurrentSince Sep 21, 2024 Accepting new patients
Barnabas Health Medical Group PC CurrentSince Sep 21, 2024 Accepting new patients
New York City Health and Hospitals Corporation Past Accepting new patients

Locations

475 Route 70
Ste 101
Lakewood, NJ 08701
Phone (732) 364-8000

200 S Orange Ave
Ste 102
Livingston, NJ 07039
Phone (973) 322-7020

112 Old Short HLS Rd
Livingston, NJ 07039

94 Old Short Hills Rd
Livingston, NJ 07039
Phone (973) 322-5400

1 Rwj Pl
New Brunswick, NJ 08901
Phone (732) 235-7887

379 Campus Dr
Fl 4
Somerset, NJ 08873
Phone (732) 507-6545

Interoperability endpoints

  • Direct secure messaging: sryllo3769450@nychhc.direct-ci.com

Organizations & group practices 5

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.

Hospital & facility affiliations 1

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": "1688342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729641600000",
    "number": "1477230308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "379 CAMPUS DR FL 4",
            "city": "SOMERSET",
            "state": "NJ",
            "postal_code": "088731161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 S ORANGE AVE STE 102",
            "city": "LIVINGSTON",
            "state": "NJ",
            "postal_code": "070395817",
            "telephone_number": "973-322-7020"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1901 1st Ave",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100297491",
            "country_code": "US",
            "telephone_number": "212-423-6262",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RYLLO",
        "first_name": "SAMANTHA",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-07-03",
        "last_updated": "2024-10-23",
        "certification_date": "2024-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "030278",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00876300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Livingston, NJ

Sources for this page

Verify at the official NPI Registry.