Prime Healthcare, PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

PRIME HEALTHCARE, PC

Practice address

30 Jordan LN
Wethersfield, CT 06109-1278

Phone

(860) 263-0253

Fax

(860) 263-0262

NPI assigned

Sep 11, 2007

Last updated

Aug 3, 2015By 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

Susan Albano

Title

Ceo

Phone

(860) 263-0253

Specialties & licenses 12

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Prime Healthcare (Sleep Lab)

  • Sleep Disorder Diagnostic Clinic/Center
  • Wethersfield, CT
  • NPI 1184832354

  O20040121000411

  Same enrollment

Locations

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Ajt Urology LLC

  • Non-Pharmacy Dispensing Site
  • Bloomfield, CT
  • NPI 1760283576
  NPPES parent name
• Prime Healthcare Iod

  • Non-Pharmacy Dispensing Site
  • Bloomfield, CT
  • NPI 1710870696
  NPPES parent name

Practitioners 140

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.

• Haley Rose Albano, APRN

  • Family Nurse Practitioner
  • Bloomfield, CT
  • NPI 1295610913
  Medicare reassignment Care Compare group NPD
• Nanette Alexander, APRN

  • Adult Health Nurse Practitioner
  • Glastonbury, CT
  • NPI 1568449262
  Medicare reassignment Care Compare group NPD
• Radhika Naga Ayyagari, MD

  • Gastroenterology Physician
  • Avon, CT
  • NPI 1598109753

  Multi-Specialty

  Medicare reassignment Care Compare group NPD
• Jeremy Ronald Baker, PA

  • Medical Physician Assistant
  • Hartford, CT
  • NPI 1295373785
  Medicare reassignment Care Compare group NPD
• Tapas Bandyopadhyay, MD

  • Pulmonary Disease Physician
  • West Hartford, CT
  • NPI 1861491839

  Critical Care Medicine

  Medicare reassignment Care Compare group NPD
• Jennifer Elizabeth Baranowski, APRN, NP-C

  • Family Nurse Practitioner
  • Avon, CT
  • NPI 1336813393
  Medicare reassignment Care Compare group NPD
• Jasveen Batra

  • Family Medicine Physician
  • Wethersfield, CT
  • NPI 1497218986
  Medicare reassignment Care Compare group NPD
• Lynne Benjamin, APRN

  • Family Nurse Practitioner
  • Avon, CT
  • NPI 1134528946
  Medicare reassignment Care Compare group NPD
• Amber Christel Berry, ANP-BC, MSN

  • Adult Health Nurse Practitioner
  • Wethersfield, CT
  • NPI 1821426487
  Medicare reassignment Care Compare group NPD
• Brittany Bordonaro, PA-C

  • Medical Physician Assistant
  • Hartford, CT
  • NPI 1548630999
  Medicare reassignment Care Compare group NPD
• Monique Marie Brunelle, DNP, APRN, FNP-BC

  • Family Nurse Practitioner
  • Bolton, CT
  • NPI 1770368532
  Medicare reassignment Care Compare group NPD
• Sebastiano Buccheri, MD

  • Internal Medicine Physician
  • West Hartford, CT
  • NPI 1881221588
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1189468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438560000000",
    "number": "1184819302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 JORDAN LN",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061091278",
            "telephone_number": "860-263-0253",
            "fax_number": "860-263-0262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 JORDAN LN",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061091278",
            "telephone_number": "860-263-0253",
            "fax_number": "860-263-0262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME HEALTHCARE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-11",
        "last_updated": "2015-08-03",
        "status": "A",
        "authorized_official_last_name": "ALBANO",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "860-263-0253"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CT",
            "license": "54316",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004185147",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004201480",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008058707",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Lynn Portal
• Carol C. Portman
• Power to Grow LLC
• Prime Healthcare (Sleep Lab)
• Prime Healthcare LTC PC
• Prince Lactation Support, LLC
• Kelly Krupa Prior, APRN
• Leah Michelle Procko, MS, CCC-SLP
• Prosperity & Wellness Clinic, LLC (Prosperity & Wellness)
• Prosthetic and Orthotic Specialists of Connecticut

• Internal Medicine Physician in Wethersfield, CT
• Providers in Wethersfield, CT by specialty
• Internal Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.