Active NPI
Anna M. Timell, M.D.
- Family Medicine Physician
- Waterbury, CT
National Provider Identifier
1013929769
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 180857
- Practice address
- 1302 S Main St
Waterbury, CT 06706-1748 - Phone
- (203) 756-8021
- Fax
- (203) 596-9038
- NPI assigned
- Aug 12, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 180857 | NY | Primary |
Addresses
Primary practice location
1302 S Main St
Waterbury, CT 06706-1748
Mailing address
80 Phoenix Ave
Waterbury, CT 06702-1418
Phone (203) 756-8021
Other practice location 1
80 Phoenix Ave
Waterbury, CT 06702-1418
Phone (203) 756-8021
Other practice location 2
3174 Route 22
Hudson River Healthcare, Inc.
Dover Plains, NY 12522-5924
Phone (845) 877-4793
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013929769 | Other | CT | ANTHEM BCBS |
| 01093136 | Medicaid | NY | |
| 003111408 | Medicaid | CT |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155340800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1013929769",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "80 PHOENIX AVE",
"city": "WATERBURY",
"state": "CT",
"postal_code": "067021418",
"telephone_number": "203-756-8021",
"fax_number": "203-596-9038"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1302 S MAIN ST",
"city": "WATERBURY",
"state": "CT",
"postal_code": "067061748",
"telephone_number": "203-756-8021",
"fax_number": "203-596-9038"
}
],
"practiceLocations": [
{
"address_1": "80 Phoenix Ave",
"address_purpose": "LOCATION",
"city": "Waterbury",
"state": "CT",
"postal_code": "067021418",
"country_code": "US",
"telephone_number": "203-756-8021",
"fax_number": "203-596-9038",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3174 Route 22",
"address_2": "HUDSON RIVER HEALTHCARE, INC.",
"address_purpose": "LOCATION",
"city": "Dover Plains",
"state": "NY",
"postal_code": "125225924",
"country_code": "US",
"telephone_number": "845-877-4793",
"fax_number": "845-877-9212",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "TIMELL",
"first_name": "ANNA",
"middle_name": "M.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-12",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NY",
"license": "180857",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBS",
"identifier": "1013929769",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01093136",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003111408",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waterbury, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.