NPIMap

Individual provider Active NPI

Samuel Hoffman

  • Emergency Medical Services (Emergency Medicine) Physician
  • West Islip, NY
National Provider Identifier
1700406980
Registry record updated Sep 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X
License
036169400 Issued in IL
Practice address
1000 Montauk Hwy
West Islip, NY 11795-4927
Phone
(631) 376-3000
Fax
(631) 376-3420
NPI assigned
Apr 17, 2020
Last updated
Sep 6, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 6, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X 036169400 IL Primary

Addresses

Primary practice location

1000 Montauk Hwy
West Islip, NY 11795-4927

Mailing address

180 N Jefferson St Unit 1410
Chicago, IL 60661-1463
Phone (516) 574-3625

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241009001566 IL Practitioner - Emergency Medicine 3274064613 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
New York College of Osteo Medicine of New York Institute of Technology, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Illinois Emergency Medicine Specialists LLCGroup PAC ID 6103071808, 43 clinicians

Practice addresses (Care Compare)

500 Remington Blvd
Bolingbrook, IL 60440-4906
Phone (630) 312-5000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036169400ILMDEmergency Medical Services (Emergency Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Illinois Emergency Medicine Specialists, LLC Emergency Medical Services CurrentSince Aug 15, 2024 Accepting new patients
Insight Chicago, Inc. CurrentSince Jan 7, 2025 Accepting new patients
Insight Chicago, Inc. CurrentSince Jan 7, 2025 Accepting new patients

Locations

500 Remington Blvd
Bolingbrook, IL 60440
Phone (630) 312-5000

2525 S Michigan Ave
Chicago, IL 60616
Phone (312) 355-1153

120 N Oak St
Oak Brook Mall, IL 60521
Phone (630) 856-6700

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1587081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725580800000",
    "number": "1700406980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 N JEFFERSON ST UNIT 1410",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606611463",
            "telephone_number": "516-574-3625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 MONTAUK HWY",
            "city": "WEST ISLIP",
            "state": "NY",
            "postal_code": "117954927",
            "telephone_number": "631-376-3000",
            "fax_number": "631-376-3420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOFFMAN",
        "first_name": "SAMUEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-04-17",
        "last_updated": "2024-09-06",
        "certification_date": "2024-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "IL",
            "license": "036169400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Islip, NY

Sources for this page

Verify at the official NPI Registry.