Individual provider Active NPI

Samuel Rosario, LICSW

  • Clinical Social Worker
  • Peterborough, NH
National Provider Identifier
1962682591
Registry record updated May 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
324 Issued in NH
Practice address
458 Old Street Rd
Suite 202
Peterborough, NH 03458-1265
Phone
(603) 924-9490
NPI assigned
Nov 12, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 24, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 324 NH Primary

Addresses

Primary practice location

458 Old Street Rd
Suite 202
Peterborough, NH 03458-1265

Mailing address

458 Old Street Rd
Suite 202
Peterborough, NH 03458-1265
Phone (603) 924-9490

Other identifiers 2

IdentifierTypeStateIssuer
RE161402OtherNHMEDICARE PTAN
30426923MedicaidNH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH, MA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20080221000106 NH Practitioner - Clinical Social Worker 9335223965 Reassigns benefits to 1 organization
I20250109003233 MA Practitioner - Clinical Social Worker 9335223965 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1985
Medicare assignment
May accept Medicare assignment
Group practices

Practice addresses (Care Compare)

130 Water St
Suite 4
Fitchburg, MA 01420-5478
Phone (978) 878-8110

175 Connors St
Gardner, MA 01440-2637
Phone (978) 410-6100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
324NHMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Connections, Inc. CurrentSince Dec 11, 2024 Accepting new patients
Community Health Connections, Inc. Current Accepting new patients
Community Health Connections, Inc. CurrentSince Dec 11, 2024 Accepting new patients
Monadnock Family Services Past Accepting new patients
Monadnock Community Hospital Past Accepting new patients

Locations

130 Water St
Ste 4
Fitchburg, MA 01420
Phone (978) 868-9944

326 Nichols Rd
Fitchburg, MA 01420
Phone (978) 343-5270

175 Connors St
Gardner, MA 01440
Phone (978) 410-6100

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1194825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306195200000",
    "number": "1962682591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "458 OLD STREET RD",
            "address_2": "SUITE 202",
            "city": "PETERBOROUGH",
            "state": "NH",
            "postal_code": "034581265",
            "telephone_number": "603-924-9490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "458 OLD STREET RD",
            "address_2": "SUITE 202",
            "city": "PETERBOROUGH",
            "state": "NH",
            "postal_code": "034581265",
            "telephone_number": "603-924-9490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSARIO",
        "first_name": "SAMUEL",
        "name_prefix": "Mr.",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-12",
        "last_updated": "2011-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NH",
            "license": "324",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "RE161402",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30426923",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peterborough, NH

Sources for this page

Verify at the official NPI Registry.