SAM S SONG – Gerontology Nurse Practitioner, NPI 1255160917

SAM S SONG is a healthcare provider. based in Norwood, Massachusetts. specializing in NURSE PRACTITIONER. They hold a License No. RN2352469 (MA). The NPI Number for SAM S SONG is 1255160917

Main info

Male
3 Years Of Experience
Accepts Medicare Assignment
Name
SAM S SONG
NPI
1255160917
Phone
Not provided
Address
1177 PROVIDENCE HIGHWAY
Enumeration Date
31 July 2024
Last Update Date
11 October 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6173252800
Graduation Year
2023 (3 years ago)
PAC ID
0941740757
Group Practice PAC ID
4789588641
Professional Enrollment ID
I20240907000264
Address ID
MA024673628CH291XXDRXX300
Telehealth
Yes
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience31
Completeness75
Years active:1State licenses:1Digital endpointsOther names

8,972 NURSE PRACTITIONER in MA

Provider Addresses for SAM S SONG

  • 1177 PROVIDENCE HIGHWAY

    NORWOOD, MA 02062

    Phone:

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2024-09-07

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20240907000264INurse PractitionerMATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 02062)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 4789588641View full group profile
NameSpecialtyState
-MA
Family PracticeMA
D E R M A T O L O G YMA
Emergency MedicineMA
Internal Medicine, Cardiovascular Disease (Cardiology)MA
-MA
O B S T E T R I C S/ G Y N E C O L O G YMA
-MA
Internal MedicineMA
O T O L A R Y N G O L O G YMA

Reviews

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Frequently asked questions

Where can patients find SAM S SONG's NPI?
You can confirm SAM S SONG with NPI 1255160917; it appears in the national provider directory.
Does this profile mean SAM S SONG is currently active?
Yes — SAM S SONG appears active in the national provider directory.
What field does SAM S SONG work in?
You can think of SAM S SONG as practicing within Gerontology Nurse Practitioner. Clinical services aligned with this taxonomy classification.
What location shows for SAM S SONG?
We surface Norwood, Massachusetts for SAM S SONG based on available NPPES addresses.
What if Norwood, Massachusetts seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

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