Individual provider Active NPI

Susan Bartlett, MA

  • Audiologist
  • Storrs Mansfield, CT
National Provider Identifier
1114923638
Registry record updated Apr 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
000626 Issued in CT
Practice address
850 Bolton Rd # U-85
Storrs Mansfield, CT 06269-9020
Phone
(860) 486-2629
Fax
(860) 486-5422
NPI assigned
Jun 21, 2005
Last updated
Apr 15, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 000626 CT Primary

Addresses

Primary practice location

850 Bolton Rd # U-85
Storrs Mansfield, CT 06269-9020

Mailing address

65 Kane St
Provider Enrollment-Ellie Atkins
West Hartford, CT 06119-2110
Phone (860) 523-6421

Other identifiers 1

IdentifierTypeStateIssuer
004070496MedicaidCT

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
Master of Arts

State licenses

LicenseStateTypeSpecialty
000626CTMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
University of Connecticut Health Center Past Accepting new patients
State of Connecticut Health Center Past Accepting new patients
University of Connecticut Health Center Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1271289600000",
    "number": "1114923638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 KANE ST",
            "address_2": "PROVIDER ENROLLMENT-ELLIE ATKINS",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061192110",
            "telephone_number": "860-523-6421",
            "fax_number": "860-523-3701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 BOLTON RD # U-85",
            "city": "STORRS MANSFIELD",
            "state": "CT",
            "postal_code": "062699020",
            "telephone_number": "860-486-2629",
            "fax_number": "860-486-5422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BARTLETT",
        "first_name": "SUSAN",
        "credential": "MA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-21",
        "last_updated": "2010-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "CT",
            "license": "000626",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004070496",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Storrs Mansfield, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2010; 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.