Jacob Samba, MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

112121 Issued in NY

Practice address

2015 Grand Concourse
Bronx, NY 10453-4303

Phone

(718) 299-7295

Fax

(718) 299-6797

NPI assigned

Sep 8, 2022

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

Medicare fee-for-service enrollment

Enrolled in NY

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.

Enrollment records 1

Specialty

General Practice

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Progressive Care Medical Group PLLCGroup PAC ID 7113298209, 45 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Revival Home Health Care Home health agency, Staten Island, NY, CCN 337299
• The Riverside Nursing home, New York, NY, CCN 335334

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Progressive Care Medical Group, PLLC

  • Internal Medicine Physician
  • New York, NY
  • NPI 1295263796
  Medicare reassignment Care Compare group NPD
• 150 Riverside Op. LLC

  • Skilled Nursing Facility
  • New York, NY
  • NPI 1558704544
  NPD (past)

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

• 150 Riverside Op. LLC

  • Skilled Nursing Facility
  • New York, NY
  • NPI 1558704544

  Nursing home

  Care Compare affiliation
• Gamzel Ny, Inc

  • Home Health Agency
  • Staten Island, NY
  • NPI 1841233178
  Care Compare affiliation

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

{
    "created_epoch": "1662595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662595200000",
    "number": "1639890692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2626 HALPERIN AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104612631",
            "telephone_number": "718-618-0401",
            "fax_number": "347-479-1303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2015 GRAND CONCOURSE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104534303",
            "telephone_number": "718-299-7295",
            "fax_number": "718-299-6797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMBA",
        "first_name": "JACOB",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-09-08",
        "last_updated": "2022-09-08",
        "certification_date": "2022-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NY",
            "license": "112121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Parbhu Dyal Samaroo, FNP
• Sherry Samaroo, LMHC
• Mabintou Samassi
• Janaki Manasa Samavedam
• Abdoulaye Samb
• Nyeh Mabel Samba, LPN
• Nicole Caithlin Sambat-Francisco
• Alfreda Sambolah
• Jazlen Samboy
• Jennifer Samboy

• General Practice Physician in Bronx, NY
• Providers in Bronx, NY by specialty
• General Practice Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2022; 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.