Yelena Samofalov, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

223642 Issued in MA

Practice address

100 South St Ste 102
Southbridge, MA 01550-4051

Phone

(508) 765-7860

Fax

(508) 765-7861

NPI assigned

Aug 18, 2006

Sex

Female

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 MA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: yelenasamofalov@hps.allscriptsdirect.net

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.

• Umass Memorial Medical Group Inc

  • Internal Medicine Physician
  • Worcester, MA
  • NPI 1760445373

  Pediatrics

  Medicare reassignment NPD
• Umass Memorial Medical Group, Inc.

  • Urgent Care Clinic/Center
  • Oxford, MA
  • NPI 1982381018
  NPD
• Umass Memorial Health-Harrington Hospital Inc

  • General Acute Care Hospital
  • Southbridge, MA
  • NPI 1790780047
  NPD (past)
• Nbimc Trinitas Pediatric Medical Group

  • Pediatrics Physician
  • Elizabeth, NJ
  • NPI 1144288366
  NPD (past)

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546560000000",
    "number": "1780798686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40",
            "city": "SOUTHBRIDGE",
            "state": "MA",
            "postal_code": "015500040",
            "telephone_number": "508-909-7799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 SOUTH ST STE 102",
            "city": "SOUTHBRIDGE",
            "state": "MA",
            "postal_code": "015504051",
            "telephone_number": "508-765-7860",
            "fax_number": "508-765-7861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMOFALOV",
        "first_name": "YELENA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-18",
        "last_updated": "2019-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "223642",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eileen Russo, SLP
• Kathy T. Rutkin
• Owen D Ryan, LICSW
• Camille Jean Sabbey
• Christie Salisbury
• Olamide Opeyemi Samuel
• Bryan Charles Sandy, PHARM D
• Chabelis Santana
• Paul A Santolucito, M.D.
• Wanda Santos-Haynes

• Pediatrics Physician in Southbridge, MA
• Providers in Southbridge, MA by specialty
• Pediatrics Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2019; 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.

Verify at the official NPI Registry.