East Granby Family Practice LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

EAST GRANBY FAMILY PRACTICE LLC

Practice address

13 Church Rd
East Granby, CT 06026-0518

Phone

(860) 653-4526

Fax

(860) 653-5209

NPI assigned

Dec 29, 2005

Last updated

Jun 26, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Steven R Dietrich, MD

Title

Partner MD

Phone

(860) 653-4526

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kerri Helen Anderson, APRN

  • Family Nurse Practitioner
  • East Granby, CT
  • NPI 1992267660
  Medicare reassignment Care Compare group NPD
• Kimberly Diane Davis, DO

  • Family Medicine Physician
  • East Granby, CT
  • NPI 1639791379
  Medicare reassignment Care Compare group NPD
• Edward M Ewald, MD

  • Family Medicine Physician
  • East Granby, CT
  • NPI 1497732564
  Medicare reassignment Care Compare group NPD
• Elizabeth S Freedman, MD

  • Family Medicine Physician
  • East Granby, CT
  • NPI 1154308211
  Medicare reassignment Care Compare group NPD
• Khuram R Ghumman, MD, MPH, CPE, FAAFP

  • Family Medicine Physician
  • East Granby, CT
  • NPI 1447384326
  Medicare reassignment Care Compare group NPD
• David R Howlett, MD

  • Family Medicine Physician
  • East Granby, CT
  • NPI 1760469829
  Medicare reassignment Care Compare group NPD
• Alina Kluk, MD

  • Family Medicine Physician
  • East Granby, CT
  • NPI 1063032977
  Medicare reassignment Care Compare group NPD
• Daniel Michael Lerner, D.O.

  • Family Medicine Physician
  • East Granby, CT
  • NPI 1700222817
  Medicare reassignment Care Compare group NPD
• Ellen Ann Maurus

  • Family Nurse Practitioner
  • East Granby, CT
  • NPI 1316673452
  Medicare reassignment Care Compare group NPD
• Neena K Pursnani, MD

  • Family Medicine Physician
  • Windsor, CT
  • NPI 1306871355
  Medicare reassignment Care Compare group NPD
• Tejal Kothari Shaikh, D.O.

  • Family Medicine Physician
  • East Granby, CT
  • NPI 1508312893
  Medicare reassignment Care Compare group NPD
• Anna Rodis, APRN, AGPCNP-BC

  • Adult Health Nurse Practitioner
  • Philadelphia, PA
  • NPI 1700534401

  CT

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1135814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372204800000",
    "number": "1154308229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13 CHURCH RD",
            "address_2": "PO BOX 518",
            "city": "EAST GRANBY",
            "state": "CT",
            "postal_code": "060260518",
            "telephone_number": "860-653-4526",
            "fax_number": "860-653-5209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13 CHURCH RD",
            "city": "EAST GRANBY",
            "state": "CT",
            "postal_code": "060260518",
            "telephone_number": "860-653-4526",
            "fax_number": "860-653-5209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST GRANBY FAMILY PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-29",
        "last_updated": "2013-06-26",
        "status": "A",
        "authorized_official_last_name": "DIETRICH",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PARTNER MD",
        "authorized_official_telephone_number": "860-653-4526",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trinity Dejesus
• Steven R Dieterich, MD
• Devon Dusseault, PT, DPT
• East Granby Ambulance Assn
• East Granby Board of Education
• Educational Advancement Associates
• Ellsworth Medical, LLC
• Maureen Elizabeth Emery, LCSW
• Edward M Ewald, MD
• Ellen Farmer Lanctot, DC

• Family Medicine Physician in East Granby, CT
• Providers in East Granby, CT by specialty
• Family Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.