The Pediatric Care Center LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

038949 Issued in CT

Legal business name

THE PEDIATRIC CARE CENTER LLC

Practice address

780 Farmington Ave
Bristol, CT 06010-3920

Phone

(860) 589-4501

Fax

(860) 589-4502

NPI assigned

Jan 17, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Susan Adeyinka, M.D.

Title

Owner

Phone

(860) 589-4501

Specialties & licenses 2

Addresses

Other identifiers 2

Tax ID family

The Pediatric Care Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• The Pediatric Care Center, LLC

  • Pediatrics Physician
  • Bristol, CT
  • NPI 1902357163
  NPD tax ID

Locations

Practitioners 4

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

• Susan Adeola Adeife Lee, MD

  • Pediatrics Physician
  • Bristol, CT
  • NPI 1528120094

  Single Specialty

  NPD
• Joseph Claude Labell Jr., MHS, PA-C

  • Physician Assistant
  • Bristol, CT
  • NPI 1073278297
  NPD (past)
• Lisa Menillo, MD

  • Pediatrics Physician
  • Bristol, CT
  • NPI 1952309924
  NPD (past)
• Hayley Shaw, FNP-BC

  • Family Nurse Practitioner
  • Bristol, CT
  • NPI 1417711821

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1326758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326758400000",
    "number": "1144591595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "780 FARMINGTON AVE",
            "city": "BRISTOL",
            "state": "CT",
            "postal_code": "060103920",
            "telephone_number": "860-589-4501",
            "fax_number": "860-589-4502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "780 FARMINGTON AVE",
            "city": "BRISTOL",
            "state": "CT",
            "postal_code": "060103920",
            "telephone_number": "860-589-4501",
            "fax_number": "860-589-4502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PEDIATRIC CARE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-17",
        "last_updated": "2012-01-17",
        "status": "A",
        "authorized_official_last_name": "ADEYINKA",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-589-4501",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CT",
            "license": "038949",
            "primary": true
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CT",
            "license": "002742",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1528120094",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1679736870",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thaddeus W Bartles OD PC
• The Family Therapy Center LLC
• The Greater Bristol Visiting Nurse Association Inc
• The Hope Clinic, LLC
• The Hope Clinic, LLC
• The Pediatric Care Center, LLC
• Susan L Thomas, LCSW
• Jordan Thompkins
• Ann Thompson, PHARMD
• Corrie Ann Thompson, PSYD

• Specialist in Bristol, CT
• Providers in Bristol, CT by specialty
• Specialist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 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.