Active NPI
Kelly Takacs
- Certified Registered Nurse Anesthetist
- Bridgeport, CT
National Provider Identifier
1023030715
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 002251
- Practice address
- 2800 Main Street
Saint Vincents Medical Center
Bridgeport, CT 06606 - Phone
- (203) 929-7353
- Fax
- (203) 929-0756
- NPI assigned
- Jul 24, 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 |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 002251 | CT | Primary |
Addresses
Primary practice location
2800 Main Street
Saint Vincents Medical Center
Bridgeport, CT 06606
Mailing address
4 Armstrong Road
Shelton, CT 06484
Phone (203) 929-7353
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002251 | CT | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Waterbury Anesthesiology Assoc. Inc | 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 and National Provider Directory roles.
-
- Anesthesiology Physician
- Waterbury, CT
- NPI 1780631960
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1023030715",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4 ARMSTRONG ROAD",
"city": "SHELTON",
"state": "CT",
"postal_code": "06484",
"telephone_number": "203-929-7353",
"fax_number": "203-929-0756"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2800 MAIN STREET",
"address_2": "SAINT VINCENTS MEDICAL CENTER",
"city": "BRIDGEPORT",
"state": "CT",
"postal_code": "06606",
"telephone_number": "203-929-7353",
"fax_number": "203-929-0756"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAKACS",
"first_name": "KELLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "CT",
"license": "002251",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bridgeport, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.