Individual provider Active NPI

Crisanta Antoinette Simon, MD

  • Student in an Organized Health Care Education/Training Program
  • Waterbury, CT
National Provider Identifier
1154052363
Registry record updated Jun 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
56 Franklin St
Waterbury, CT 06706-1253
Phone
(203) 709-6000
NPI assigned
Jun 19, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

56 Franklin St
Waterbury, CT 06706-1253

Mailing address

248 Spring St Apt 10
Naugatuck, CT 06770-2951
Phone (443) 557-8513

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
I20220712003736 CT Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 1153702857

National Provider Directory

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

Interoperability endpoints

  • Direct secure messaging: csimon2389563@direct.trinity-health.org

NPI Registry JSON

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

{
    "created_epoch": "1655596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655596800000",
    "number": "1154052363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "248 SPRING ST APT 10",
            "city": "NAUGATUCK",
            "state": "CT",
            "postal_code": "067702951",
            "telephone_number": "443-557-8513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56 FRANKLIN ST",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067061253",
            "telephone_number": "203-709-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIMON",
        "first_name": "CRISANTA",
        "middle_name": "ANTOINETTE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-19",
        "last_updated": "2022-06-19",
        "certification_date": "2022-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterbury, CT

Sources for this page

Verify at the official NPI Registry.