Individual provider Active NPI

Ana Graciela Azueta-Jimenez, MD

  • Internal Medicine Physician
  • Shelton, CT
National Provider Identifier
1083293518
Registry record updated Oct 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
79119 Issued in CT
Practice address
760 River Rd
Shelton, CT 06484-5430
Phone
(203) 380-5282
NPI assigned
Apr 2, 2021
Last updated
Oct 28, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 79119 CT Primary

Addresses

Primary practice location

760 River Rd
Shelton, CT 06484-5430

Mailing address

760 River Rd
Shelton, CT 06484-5430

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241007002378 CT Practitioner - Internal Medicine 2961933528 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Northeast Medical Group IncGroup PAC ID 1254233836, 1,357 clinicians

Practice addresses (Care Compare)

999 Silver LN
Trumbull, CT 06611-5343
Phone (203) 385-1111

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
79119CTMDAddiction (Substance Use Disorder) Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Medical Group, Inc. Internal Medicine CurrentSince Oct 1, 2024 Accepting new patients
Mill Hill Medical Consultants Inc CurrentSince Oct 1, 2024 Accepting new patients

Locations

2800 Main St
Bridgeport, CT 06606
Phone (203) 386-0366

760 River Rd
Shelton, CT 06484
Phone (203) 337-2600

95 Armory Rd
Stratford, CT 06614
Phone (203) 384-3388

999 Silver Ln
Trumbull, CT 06611
Phone (203) 380-5270

Interoperability endpoints

  • Direct secure messaging: aazueta577402@direct.ochin.org
  • Direct secure messaging: aazuetajimenez690266@direct.ynhh.org

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1617321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730073600000",
    "number": "1083293518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "760 RIVER RD",
            "city": "SHELTON",
            "state": "CT",
            "postal_code": "064845430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "760 RIVER RD",
            "city": "SHELTON",
            "state": "CT",
            "postal_code": "064845430",
            "telephone_number": "203-380-5282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AZUETA-JIMENEZ",
        "first_name": "ANA GRACIELA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-02",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "79119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelton, CT

Sources for this page

Verify at the official NPI Registry.