Individual provider Active NPI

Larisa Yelunina, M.D.

  • Psychiatry Physician
  • Hartford, CT
National Provider Identifier
1265647713
Registry record updated Mar 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
048293 Issued in CT
Practice address
675 Tower Ave Ste 301
Hartford, CT 06112-1274
Phone
(860) 714-2750
NPI assigned
May 10, 2007
Last updated
Mar 15, 2017By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 15, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 048293 CT Primary

Addresses

Primary practice location

675 Tower Ave Ste 301
Hartford, CT 06112-1274

Mailing address

675 Tower Ave Ste 301
Hartford, CT 06112-1274
Phone (860) 714-2750

Other identifiers 1

IdentifierTypeStateIssuer
1265647713MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100329000000 CT Practitioner - Psychiatry 4486780566 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
State of ConnecticutGroup PAC ID 8022915677, 267 clinicians

Practice addresses (Care Compare)

1000 Silver St
Middletown, CT 06457-3940
Phone (860) 262-5000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
048293CTMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
State of Connecticut CurrentSince Mar 4, 2016 Accepting new patients
State of Connecticut CurrentSince Mar 4, 2016 Accepting new patients

Locations

450 Columbus Blvd
Ste 1001
Hartford, CT 06103

Organizations & group practices 2

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": "1178755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489536000000",
    "number": "1265647713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 TOWER AVE STE 301",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061121274",
            "telephone_number": "860-714-2750",
            "fax_number": "860-714-8591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 TOWER AVE STE 301",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061121274",
            "telephone_number": "860-714-2750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YELUNINA",
        "first_name": "LARISA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-10",
        "last_updated": "2017-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CT",
            "license": "048293",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1265647713",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hartford, CT

Sources for this page

Verify at the official NPI Registry.