Active NPI
Ruby J Sampson, MD
- Gastroenterology Physician
- So Orange, NJ
National Provider Identifier
1619982014
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- 45315
- Practice address
- 106 Valley Street
1St Floor
So Orange, NJ 07079 - Phone
- (973) 313-9300
- Fax
- (973) 313-2313
- NPI assigned
- Jul 31, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | 45315 | NJ | Primary |
Addresses
Primary practice location
106 Valley Street
1St Floor
So Orange, NJ 07079
Mailing address
106 Valley Street
1St Floor
So Orange, NJ 07079
Phone (973) 313-9300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3357805 | Medicaid | NJ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101007000102 | NJ | Practitioner - Gastroenterology | 1355533597 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 45315 | NJ | MD | Gastroenterology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1619982014",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "106 VALLEY STREET",
"address_2": "1ST FLOOR",
"city": "SO ORANGE",
"state": "NJ",
"postal_code": "07079",
"telephone_number": "973-313-9300",
"fax_number": "973-313-2313"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "106 VALLEY STREET",
"address_2": "1ST FLOOR",
"city": "SO ORANGE",
"state": "NJ",
"postal_code": "07079",
"telephone_number": "973-313-9300",
"fax_number": "973-313-2313"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAMPSON",
"first_name": "RUBY",
"middle_name": "J",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "NJ",
"license": "45315",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3357805",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in So Orange, NJ
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.