Wallingford Endoscopy Center, LLC.

Primary specialty

Endoscopy Clinic/CenterTaxonomy code 261QE0800X

Legal business name

WALLINGFORD ENDOSCOPY CENTER, LLC.

Practice address

863 N Main Street Ext Ste 300
Wallingford, CT 06492-2434

Phone

(714) 766-5882

NPI assigned

May 2, 2018

Organization subpart

No

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

Authorized official

Name

Jeffrey Nestler, MD

Title

Medical Director

Phone

(203) 309-6096

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Listed as

Wallingford Endoscopy Center LLCCCN 07C0001066

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Midstate Medical Center

  • Psychiatric Hospital Unit
  • Meriden, CT
  • NPI 1316022718

  Member Of

  NPD member

Practitioners 2

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

• Kevin Jo, M.D.

  • Gastroenterology Physician
  • Meriden, CT
  • NPI 1003823683
  NPD
• Maria Elena Johnson, M.D.

  • Gastroenterology Physician
  • Hartford, CT
  • NPI 1033300728
  NPD (past)

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

{
    "created_epoch": "1525219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1546992000000",
    "number": "1255820544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "863 N MAIN STREET EXT STE 300",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064922434",
            "telephone_number": "203-309-6096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "863 N MAIN STREET EXT STE 300",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064922434",
            "telephone_number": "714-766-5882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLINGFORD ENDOSCOPY CENTER, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-02",
        "last_updated": "2019-01-09",
        "status": "A",
        "authorized_official_last_name": "NESTLER",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "203-309-6096",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QE0800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Endoscopy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wal-Mart Stores East, LP.
• Walgreen Co
• Allison Wall
• Wallingford Dental Associates
• Wallingford Dialysis Care LLC
• Wallingford Eye Care Center P.C.
• Wallingford Medical Associates LLC
• Wallingford Optical, LLC
• Wallingford Physical Therapy
• Ian B Walters, MD

• Endoscopy Clinic/Center in Wallingford, CT
• Providers in Wallingford, CT by specialty
• Endoscopy Clinic/Center in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2019; 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.