Westside Medical Group

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

WESTSIDE MEDICAL GROUP

Practice address

714 Chase Parkway
Suite 6
Waterbury, CT 06708-3939

Phone

(203) 755-4577

Fax

(203) 756-3628

NPI assigned

Aug 30, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Mark Lawrence Kraus, MDNPI 1851493969

Title

President

Phone

(203) 755-4577

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark Lawrence Kraus, MD

  • Internal Medicine Physician
  • Waterbury, CT
  • NPI 1851493969
  NPD Authorized official

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327276800000",
    "number": "1083724967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "714 CHASE PARKWAY",
            "address_2": "SUITE 6",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067083939",
            "telephone_number": "203-755-4577",
            "fax_number": "203-756-3628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "714 CHASE PARKWAY",
            "address_2": "SUITE 6",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067083939",
            "telephone_number": "203-755-4577",
            "fax_number": "203-756-3628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTSIDE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2012-01-23",
        "status": "A",
        "authorized_official_last_name": "KRAUS",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "LAWRENCE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "203-755-4577",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004085800",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "50WESTSIDECT01",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Waterbury, CT
• Providers in Waterbury, CT by specialty
• Internal Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.