Active NPI
Jeffrey Peter Sam
- Dentist
- New Haven, CT
National Provider Identifier
1992499289
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 13806
- Practice address
- 122 Amity Rd
New Haven, CT 06515-1405 - Phone
- (203) 389-9600
- NPI assigned
- Jun 8, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 13806 | CT | Primary |
Addresses
Primary practice location
122 Amity Rd
New Haven, CT 06515-1405
Mailing address
22 September LN
Shelton, CT 06484-5753
Phone (203) 414-7782
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230721002316 | CT | Order and Referring Only - Dentist | 3678933637 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1686182400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686182400000",
"number": "1992499289",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22 SEPTEMBER LN",
"city": "SHELTON",
"state": "CT",
"postal_code": "064845753",
"telephone_number": "203-414-7782"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "122 AMITY RD",
"city": "NEW HAVEN",
"state": "CT",
"postal_code": "065151405",
"telephone_number": "203-389-9600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAM",
"first_name": "JEFFREY",
"middle_name": "PETER",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-06-08",
"last_updated": "2023-06-08",
"certification_date": "2023-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CT",
"license": "13806",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Haven, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2023; 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.