Connecticut Back Center LLC

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

Legal business name

CONNECTICUT BACK CENTER LLC

Practice address

460 Hartford Tpke Ste B
Vernon, CT 06066-4847

Phone

(860) 872-6229

Fax

(860) 872-6252

NPI assigned

Oct 1, 2020

Organization subpart

Yes

Parent organization

CONNECTICUT BACK CENTERAs reported in NPPES

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

Authorized official

Name

Jesse Eisler, MDNPI 1326017617

Title

Owner

Phone

(860) 268-3349

Specialties & licenses 1

Addresses

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.

• Connecticut Back Center LLC

  • Orthopaedic Surgery Physician
  • Vernon, CT
  • NPI 1174564942

  O20050913000195

  Same enrollment

Part of

Connecticut Back Center LLC

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Connecticut Back Center LLC

  • Orthopaedic Surgery Physician
  • Vernon, CT
  • NPI 1174564942
  NPPES parent name

Practitioners 7

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

• Jesse Eisler, M.D.

  • Orthopaedic Surgery Physician
  • Vernon, CT
  • NPI 1326017617
  NPD Authorized official
• Christine Bergeron, PT

  • Physical Therapist
  • Manchester, CT
  • NPI 1518976489
  NPD
• Andrew Paul Thomas Gregory, D.C., FNP-C, R.NCS.T

  • Family Nurse Practitioner
  • Vernon, CT
  • NPI 1114961703
  NPD
• Betty Joseph, PT

  • Physical Therapist
  • Bloomfield, CT
  • NPI 1346207073
  NPD
• Justin J Lecuyer, PA-C

  • Surgical Physician Assistant
  • Hartford, CT
  • NPI 1184335374
  NPD
• Shahin Shaikh, PA-C

  • Physician Assistant
  • Hamden, CT
  • NPI 1649655226
  NPD
• Ashish Upadhyay, MD

  • Orthopaedic Surgery of the Spine Physician
  • Waterbury, CT
  • NPI 1689873457
  NPD

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

{
    "created_epoch": "1601510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601510400000",
    "number": "1245837384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "460 HARTFORD TPKE STE B",
            "city": "VERNON",
            "state": "CT",
            "postal_code": "060664847",
            "telephone_number": "860-872-6229",
            "fax_number": "860-872-6252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "460 HARTFORD TPKE STE B",
            "city": "VERNON",
            "state": "CT",
            "postal_code": "060664847",
            "telephone_number": "860-872-6229",
            "fax_number": "860-872-6252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNECTICUT BACK CENTER LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CONNECTICUT BACK CENTER",
        "enumeration_date": "2020-10-01",
        "last_updated": "2020-10-01",
        "certification_date": "2020-10-01",
        "status": "A",
        "authorized_official_last_name": "EISLER",
        "authorized_official_first_name": "JESSE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-268-3349",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Orthopedic Physical Therapist in Vernon, CT
• Providers in Vernon, CT by specialty
• Orthopedic Physical Therapist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2020; 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.