Granby Ambulance Association, Incorporated

Primary specialty

AmbulanceTaxonomy code 341600000X

License

C056B1 Issued in CT

Legal business name

GRANBY AMBULANCE ASSOCIATION, INCORPORATED

Practice address

1 Pegville Road
Granby, CT 06035-1615

Phone

(860) 653-6535

Fax

(888) 965-4620

NPI assigned

Aug 15, 2005

Last updated

Jun 4, 2020By 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

Lori Dibattisto

Title

Prestident

Phone

(860) 653-6535

Specialties & licenses 2

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

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

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1124064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591228800000",
    "number": "1265434690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 PEGVILLE ROAD",
            "city": "GRANBY",
            "state": "CT",
            "postal_code": "060351615",
            "telephone_number": "860-653-6535",
            "fax_number": "888-965-4620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 PEGVILLE ROAD",
            "city": "GRANBY",
            "state": "CT",
            "postal_code": "060351615",
            "telephone_number": "860-653-6535",
            "fax_number": "888-965-4620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANBY AMBULANCE ASSOCIATION, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-15",
        "last_updated": "2020-06-04",
        "certification_date": "2020-06-04",
        "status": "A",
        "authorized_official_last_name": "DIBATTISTO",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "PRESTIDENT",
        "authorized_official_telephone_number": "860-653-6535"
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "CT",
            "license": "C056B1",
            "primary": true
        },
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "590010949",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONNECTICARE",
            "identifier": "706607",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE FAMILY",
            "identifier": "00414973900",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LABOR",
            "identifier": "204062000",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004149739",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "710C056B1CT01",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa Michelle Garcia, DPT
• Meghan Garrett, PTA
• Anna Gavel, PHARMD
• Brynna Geiselmann, RN, IBCLC
• Geriatric Care Network, LLC
• Granby Dental, LLC
• Granby Family Eye Care
• Granby Pharmacy LLC (Granby Pharmacy)
• Granby Public Schools
• Granby Urgent Care LLC

• Ambulance in Granby, CT
• Providers in Granby, CT by specialty
• Ambulance in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2020; 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.