NPIMap

Organization Active NPI

Healing Edge Medical Associates LLC

  • Preventive Medicine/Occupational Environmental Medicine Physician
  • East Granby, CT
National Provider Identifier
1134450828
Registry record updated Jun 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preventive Medicine/Occupational Environmental Medicine PhysicianTaxonomy code 2083P0500X
License
036511 Issued in CT
Legal business name
HEALING EDGE MEDICAL ASSOCIATES LLC
Practice address
29 Kripes Rd
Suite M
East Granby, CT 06026-9669
Phone
(860) 413-3883
Fax
(860) 413-3884
NPI assigned
Jan 20, 2010
Organization subpart
No

Practitioners 1

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

National Provider Directory

National Provider Directory

Locations

29 Kripes Rd
Ste M
East Granby, CT 06026
Phone (860) 413-3883

NPPES NPI Registry

Updated by the provider on Jun 19, 2013

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

Authorized official

Name
Dr. Ronald Dale Agnes Jr., M.D.
Title
President/Physician
Phone
(860) 978-8825

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X 036511 CT
Preventive Medicine/Occupational Environmental Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2083P0500X 036511 CT Primary

Addresses

Primary practice location

29 Kripes Rd
Suite M
East Granby, CT 06026-9669

Mailing address

PO Box 152
Simsbury, CT 06070-0152
Phone (860) 978-8825

Other identifiers 2

IdentifierTypeStateIssuer
3097037MedicaidIL
J13195OtherILMEDICARE

NPI Registry JSON

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

{
    "created_epoch": "1263945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371600000000",
    "number": "1134450828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 152",
            "city": "SIMSBURY",
            "state": "CT",
            "postal_code": "060700152",
            "telephone_number": "860-978-8825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 KRIPES RD",
            "address_2": "SUITE M",
            "city": "EAST GRANBY",
            "state": "CT",
            "postal_code": "060269669",
            "telephone_number": "860-413-3883",
            "fax_number": "860-413-3884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALING EDGE MEDICAL ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-20",
        "last_updated": "2013-06-19",
        "status": "A",
        "authorized_official_last_name": "AGNES",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "DALE",
        "authorized_official_title_or_position": "PRESIDENT/PHYSICIAN",
        "authorized_official_telephone_number": "860-978-8825",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": "CT",
            "license": "036511",
            "primary": false
        },
        {
            "code": "2083P0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine",
            "state": "CT",
            "license": "036511",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3097037",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "J13195",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Granby, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2013; 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.