Individual provider Active NPI

Lewis R Samuel, MD

  • Diagnostic Radiology Physician
  • Voorhees, NJ
National Provider Identifier
1861486169
Registry record updated Nov 27, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
25MA04580400 Issued in NJ
Practice address
100 Carnie Blvd
Suite B-5 South Jersey Radiology Associates
Voorhees, NJ 08043-4512
Phone
(856) 751-0123
Fax
(856) 751-0535
NPI assigned
Sep 1, 2005
Last updated
Nov 27, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 25MA04580400 NJ Primary

Addresses

Primary practice location

100 Carnie Blvd
Suite B-5 South Jersey Radiology Associates
Voorhees, NJ 08043-4512

Mailing address

South Jersey Radiology Associates, PA
PO Box 23355
Newark, NJ 07189-0001
Phone (856) 770-0300

Other identifiers 7

IdentifierTypeStateIssuer
0536797000OtherAMERIHEALTH
SA701402OtherHIGHMARK PA BLUE SHIELD
0814136OtherAETNA
1241866OtherUNITED HEALTHCARE
A3738029OtherOXFORD HEALTH
1089280OtherHORIZON NJ HEALTH
2420104MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MA04580400NJMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
South Jersey Radiology Associates P a Diagnostic Radiology Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1125532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196121600000",
    "number": "1861486169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "SOUTH JERSEY RADIOLOGY ASSOCIATES, PA",
            "address_2": "PO BOX 23355",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071890001",
            "telephone_number": "856-770-0300",
            "fax_number": "856-770-0395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 CARNIE BLVD",
            "address_2": "SUITE B-5 SOUTH JERSEY RADIOLOGY ASSOCIATES",
            "city": "VOORHEES",
            "state": "NJ",
            "postal_code": "080434512",
            "telephone_number": "856-751-0123",
            "fax_number": "856-751-0535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMUEL",
        "first_name": "LEWIS",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-01",
        "last_updated": "2007-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NJ",
            "license": "25MA04580400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH",
            "identifier": "0536797000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK PA BLUE SHIELD",
            "identifier": "SA701402",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0814136",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1241866",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD HEALTH",
            "identifier": "A3738029",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HORIZON NJ HEALTH",
            "identifier": "1089280",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2420104",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Voorhees, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2007; 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.