Individual provider Active NPI

Samantha Blaine, MD

  • Emergency Medicine Physician
  • Stony Brook, NY
National Provider Identifier
1497440036
Registry record updated May 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
342260 Issued in NY
Practice address
101 Nicolls Rd
Stony Brook, NY 11794-8350
Phone
(631) 444-3880
Fax
(631) 444-3919
NPI assigned
Apr 10, 2023
Last updated
May 23, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 342260 NY Primary

Addresses

Primary practice location

101 Nicolls Rd
Stony Brook, NY 11794-8350

Mailing address

101 Nicolls Road
HSC Level 4 Room 050
Stony Brook, NY 11794-8350
Phone (631) 444-3880

Medicare participation

Medicare enrollment files
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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2023
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

PO Box
Suite 1554
Stony Brook, NY 11790

PO Box
Suite 1554
Stony Brook, NY 11790-0988

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
342260NYMDEmergency Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1681084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779494400000",
    "number": "1497440036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 NICOLLS ROAD",
            "address_2": "HSC LEVEL 4 ROOM 050",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117948350",
            "telephone_number": "631-444-3880",
            "fax_number": "631-444-3919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 NICOLLS RD",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117948350",
            "telephone_number": "631-444-3880",
            "fax_number": "631-444-3919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAINE",
        "first_name": "SAMANTHA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-10",
        "last_updated": "2026-05-23",
        "certification_date": "2026-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "342260",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stony Brook, NY

Sources for this page

Verify at the official NPI Registry.