Samuel Carruth Jr., MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

25MA07029000 Issued in NJ

Practice address

485 Park Ave
Orange, NJ 07050-1721

Phone

(973) 672-2770

Fax

(973) 672-2770

NPI assigned

May 25, 2006

Sex

Male

Sole proprietor

No

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.

• Gemstone Pediatrics

  • Pediatrics Physician
  • Orange, NJ
  • NPI 1285255539

  Pediatrics

  NPD Authorized official

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sam@mct.pcc-direct.com

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 29, 2020.

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588118400000",
    "number": "1841246675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 SALTER PL",
            "city": "MAPLEWOOD",
            "state": "NJ",
            "postal_code": "070402629",
            "telephone_number": "973-762-2562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "485 PARK AVE",
            "city": "ORANGE",
            "state": "NJ",
            "postal_code": "070501721",
            "telephone_number": "973-672-2770",
            "fax_number": "973-672-2770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARRUTH",
        "first_name": "SAMUEL",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-25",
        "last_updated": "2020-04-29",
        "certification_date": "2020-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "25MA07029000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Swhendhy Cantave
• Kevin Raymond Capriolo
• Clifford Caraway
• Care Deeply
• Careful Hearts Services
• Kenny J Casado
• Central Imaging Associates, Inc
• Cerebral Palsy of North Jersey
• Cerebral Palsy of North Jersey
• Cerebral Palsy of North Jersey

• All providers in Orange, NJ
• Pediatrics Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.