Manchester Pediatric Associates LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

043564 Issued in CT

Legal business name

MANCHESTER PEDIATRIC ASSOCIATES LLC

Practice address

2701 Tamarack Ave
South Windsor, CT 06074-5561

Phone

(860) 647-8282

Fax

(860) 647-8399

NPI assigned

Nov 9, 2010

Last updated

Mar 17, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Swathanthra Kumar Melekote, MDNPI 1629061965

Title

Owner

Phone

(860) 647-8282

Specialties & licenses 1

Addresses

Other identifiers 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Swathanthra Kumar Melekote, MD

  • Pediatrics Physician
  • Manchester, CT
  • NPI 1629061965
  NPD Authorized official
• Jennifer Bartson, CPNP-PC

  • Pediatric Nurse Practitioner
  • Tolland, CT
  • NPI 1700617057
  NPD (past)
• Frederic Jacob Bernstein, D.O.

  • Pediatrics Physician
  • South Windsor, CT
  • NPI 1306160593
  NPD (past)
• Abigail Coromoto Cipriani Amador, M.D

  • Pediatrics Physician
  • South Windsor, CT
  • NPI 1962853143
  NPD (past)
• Andrea G. Dixon, MD

  • Pediatrics Physician
  • South Windsor, CT
  • NPI 1699725929
  NPD (past)
• Tristin Elizabeth Geist, APRN

  • Pediatric Nurse Practitioner
  • Tolland, CT
  • NPI 1174066674
  NPD (past)
• Gubbanna V Kumar, MD

  • Pediatrics Physician
  • Glastonbury, CT
  • NPI 1598729931
  NPD (past)
• Rachel Lynn Maclean, PA-C

  • Physician Assistant
  • Tolland, CT
  • NPI 1043863681
  NPD (past)
• Brittany Athena Molkenthin

  • Pediatric Nurse Practitioner
  • Canterbury, CT
  • NPI 1962029660
  NPD (past)
• Scott Michael O'Brien, PA-C

  • Medical Physician Assistant
  • South Windsor, CT
  • NPI 1538279054
  NPD (past)
• John Henry Walker, M.D.

  • Pediatrics Physician
  • South Windsor, CT
  • NPI 1275500936
  NPD (past)

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

{
    "created_epoch": "1289260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1053612911",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2701 TAMARACK AVE",
            "city": "SOUTH WINDSOR",
            "state": "CT",
            "postal_code": "060745561",
            "telephone_number": "860-647-8282",
            "fax_number": "860-647-8399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 TAMARACK AVE",
            "city": "SOUTH WINDSOR",
            "state": "CT",
            "postal_code": "060745561",
            "telephone_number": "860-647-8282",
            "fax_number": "860-647-8399"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "150 Hazard Ave Bldg B",
            "address_purpose": "LOCATION",
            "city": "Enfield",
            "state": "CT",
            "postal_code": "060824587",
            "country_code": "US",
            "telephone_number": "860-749-3661",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "130 Hartford Rd",
            "address_purpose": "LOCATION",
            "city": "Manchester",
            "state": "CT",
            "postal_code": "060405921",
            "country_code": "US",
            "telephone_number": "860-647-8282",
            "fax_number": "860-647-8399",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "89 West Rd Ste 1",
            "address_purpose": "LOCATION",
            "city": "Ellington",
            "state": "CT",
            "postal_code": "060293718",
            "country_code": "US",
            "telephone_number": "860-647-8282 x108",
            "fax_number": "860-647-8399",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "52 Peck Rd Ste D",
            "address_purpose": "LOCATION",
            "city": "Torrington",
            "state": "CT",
            "postal_code": "067906107",
            "country_code": "US",
            "telephone_number": "860-482-1170",
            "fax_number": "860-647-8399",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MANCHESTER PEDIATRIC ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-09",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "MELEKOTE",
        "authorized_official_first_name": "SWATHANTHRA",
        "authorized_official_middle_name": "KUMAR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-647-8282",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CT",
            "license": "043564",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1629061965",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ameena Madan Paramasivan, M.D.,
• Christa Madden
• Emily Sarah Maloney, M.S. CCC-SLP
• Manchester Ear, Nose & Throat Center LLC
• Manchester Family Care LLC
• Mandell & Blau, MD's PC (Open MRI at Buckland Hills)
• Mandell & Blau, MD's PC (Women's Imaging of Buckland Hills)
• Laura Mandell
• Curtis Manganello, OTR
• Richard John Manganiello, M.D.

• Pediatrics Physician in South Windsor, CT
• Providers in South Windsor, CT by specialty
• Pediatrics Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.