Organization Active NPI

Alliance in Internal Medicine, LLC

  • Internal Medicine Physician
  • Enfield, CT
National Provider Identifier
1174035844
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
037342 Issued in CT
Legal business name
ALLIANCE IN INTERNAL MEDICINE, LLC
Practice address
139 Hazard Ave Ste 2
Enfield, CT 06082-4585
Phone
(860) 253-0037
NPI assigned
Nov 2, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

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

Authorized official

Name
Dr. Surendra Khera, MD, MSCNPI 1467436519
Title
MD
Phone
(860) 253-0037

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 037342 CT Primary

Addresses

Primary practice location

139 Hazard Ave Ste 2
Enfield, CT 06082-4585

Mailing address

139 Hazard Ave Ste 2
Enfield, CT 06082-4585
Phone (860) 253-0037

Other identifiers 1

IdentifierTypeStateIssuer
001373422MedicaidCT

National Provider Directory

National Provider Directory

Locations

139 Hazard Ave
Ste 2
Enfield, CT 06082
Phone (860) 253-0037

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1509580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1174035844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "139 HAZARD AVE STE 2",
            "city": "ENFIELD",
            "state": "CT",
            "postal_code": "060824585",
            "telephone_number": "860-253-0037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 HAZARD AVE STE 2",
            "city": "ENFIELD",
            "state": "CT",
            "postal_code": "060824585",
            "telephone_number": "860-253-0037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLIANCE IN INTERNAL MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-02",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "KHERA",
        "authorized_official_first_name": "SURENDRA",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "860-253-0037",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD, MSC"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "037342",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001373422",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Enfield, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; 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.