Integrated Dermatology of Groton LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

INTEGRATED DERMATOLOGY OF GROTON LLC

Practice address

481 Gold Star Hwy Ste 201
Groton, CT 06340-6702

Phone

(860) 445-8020

NPI assigned

Sep 19, 2013

Organization subpart

No

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

Authorized official

Name

Jeffrey D. Queen

Title

Manager

Phone

(561) 314-2000

Specialties & licenses 1

Addresses

Other names 1

• Eastern Connecticut Dermatology Doing business as

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

Practitioners 6

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

• Robert B. Ecker, MD

  • Dermatology Physician
  • Groton, CT
  • NPI 1811950074
  Medicare reassignment Care Compare group NPD
• Andrew Kelsey, MD

  • Dermatology Physician
  • Waterbury, CT
  • NPI 1649664731
  Medicare reassignment Care Compare group NPD
• Natalia Fanani, PA

  • Medical Physician Assistant
  • Norwich, CT
  • NPI 1164124657
  Medicare reassignment Care Compare group
• Christopher Sanford Thompson, PA-C

  • Physician Assistant
  • Groton, CT
  • NPI 1003032046
  Medicare reassignment Care Compare group
• Luanne C Hespeler, PA-C

  • Physician Assistant
  • St Petersburg, FL
  • NPI 1366527822

  CT

  Medicare reassignment
• Animesh Amart Sinha, M.D

  • Dermatology Physician
  • Williamsville, NY
  • NPI 1285733014
  NPD (past)

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

{
    "created_epoch": "1379548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547164800000",
    "number": "1265868558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 EXCHANGE CT STE 110",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334314450",
            "telephone_number": "561-314-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "481 GOLD STAR HWY STE 201",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063406702",
            "telephone_number": "860-445-8020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED DERMATOLOGY OF GROTON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-19",
        "last_updated": "2019-01-11",
        "status": "A",
        "authorized_official_last_name": "QUEEN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "561-314-2000"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eastern Connecticut Dermatology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Eastern Connecticut Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Edward E Hutter, D.C.
• Caitlin Elizabeth Hyde, PT,DPT
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• Sharon Kuriakose Iype, DDS
• Julia Jacobs, M.D.
• Vanessa Marie Janek, RN
• Richard B Jaremback, IDC

• Dermatology Physician in Groton, CT
• Providers in Groton, CT by specialty
• Dermatology Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 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.