Individual provider Active NPI

Judith Conway, APRN

  • Clinical Nurse Specialist
  • Farmington, CT
National Provider Identifier
1174510424
Registry record updated Jan 25, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Nurse SpecialistTaxonomy code 364S00000X
License
000552 Issued in CT
Practice address
263 Farmington Ave
Gastroenterology Associates
Farmington, CT 06030-0001
Phone
(860) 679-3238
Fax
(860) 679-1217
NPI assigned
Oct 3, 2005
Last updated
Jan 25, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Nurse Specialist 364S00000X 000552 CT Primary
Medical-Surgical Clinical Nurse Specialist 364SM0705X 000552 CT

Addresses

Primary practice location

263 Farmington Ave
Gastroenterology Associates
Farmington, CT 06030-0001

Mailing address

65 Kane St
Provider Enrollment, 2ND Floor
West Hartford, CT 06119-2110
Phone (860) 523-6421

Other identifiers 1

IdentifierTypeStateIssuer
4223442MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Specialist

State licenses

LicenseStateTypeSpecialty
000552CTMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Hartford Physician Services PC Past Accepting new patients
University of Connecticut Health Center Past Accepting new patients
Connecticut Children's Specialty Group, Inc. Past Accepting new patients
University of Connecticut Health Center Past Accepting new patients

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1128297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1264377600000",
    "number": "1174510424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 KANE ST",
            "address_2": "PROVIDER ENROLLMENT, 2ND FLOOR",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061192110",
            "telephone_number": "860-523-6421",
            "fax_number": "860-523-3701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "263 FARMINGTON AVE",
            "address_2": "GASTROENTEROLOGY ASSOCIATES",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060300001",
            "telephone_number": "860-679-3238",
            "fax_number": "860-679-1217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONWAY",
        "first_name": "JUDITH",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-03",
        "last_updated": "2010-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364S00000X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist",
            "state": "CT",
            "license": "000552",
            "primary": true
        },
        {
            "code": "364SM0705X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Medical-Surgical",
            "state": "CT",
            "license": "000552",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4223442",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2010; 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.