Shelley Deborah Samuel, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

199420 Issued in NY

Practice address

2015 Grand Concourse
Bronx, NY 10453

Phone

(718) 299-7295

NPI assigned

Mar 15, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 3

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

Internal Medicine

Education

Hahnemann University College of Medicine, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bronx Medical Practice PCGroup PAC ID 9739496100, 136 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H1722
• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H3359

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.

• Bronx Medical Practice P.C.

  • Internal Medicine Physician
  • Bronx, NY
  • NPI 1356726087
  Medicare reassignment Care Compare group NPD
• Essen Medical Associates, PC

  • Legal Medicine
  • Bronx, NY
  • NPI 1366418709
  Medicare reassignment NPD
• Essen Medical Associates, PC

  • Podiatrist
  • Bronx, NY
  • NPI 1720799158
  NPD
• Pelham Physical Medicine Inc

  • Specialist
  • Bronx, NY
  • NPI 1144262510
  NPD (past)
• Pelham Physical Medicine Inc

  • Rehabilitation Clinic/Center
  • Bronx, NY
  • NPI 1952465338

  Internal Medicine

  NPD (past)

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528070400000",
    "number": "1841324548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2015 GRAND CONCOURSE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104534303",
            "telephone_number": "718-299-7295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2015 GRAND CONCOURSE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "10453",
            "telephone_number": "718-299-7295"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2415 Parkwood Dr",
            "address_purpose": "LOCATION",
            "city": "Brunswick",
            "state": "GA",
            "postal_code": "315204722",
            "country_code": "US",
            "telephone_number": "912-466-7188",
            "fax_number": "478-934-4989",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAMUEL",
        "first_name": "SHELLEY",
        "middle_name": "DEBORAH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-15",
        "last_updated": "2018-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "57248",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA07183800",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "199420",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID",
            "identifier": "01920209",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8598703",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "27N951",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joshua M Samuel
• Little Ann Samuel
• Miryam Samuel
• Savannah Samuel, PA-C
• Shawn Kunjumon Samuel, DO, MS
• Stephannie Samuel
• Zachariah Samuel
• Dionne J. Samuels-Reid, RN
• Aaliyah Samuels, LMSW
• Alley Samuels

• Internal Medicine Physician in Bronx, NY
• Providers in Bronx, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2018; 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.