Robert John Kupis, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

58266 Issued in CA

Practice address

196 Parkway South
Suite 103
Waterford, CT 06385

Phone

(860) 443-4383

Fax

(860) 443-3980

NPI assigned

Jun 12, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 13

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Family Health Centers of San Diego, Inc

  dba Logan Heights Family Health Center

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1447281936
  Medicare reassignment NPD
• Family Health Centers of San Diego, Inc

  dba Escondido Physical Health and Wellness

  • Federally Qualified Health Center (FQHC)
  • Escondido, CA
  • NPI 1356178180
  NPD
• Eastern Conn. Cardiology Group

  • Cardiovascular Disease Physician
  • Waterford, CT
  • NPI 1336192608
  NPD (past)
• Eastern CT Cardiology Diagnostics, LLC

  • Cardiovascular Disease Physician
  • Waterford, CT
  • NPI 1548211188
  NPD (past)
• Jon Gaudio LLC

  • Cardiovascular Disease Physician
  • Mystic, CT
  • NPI 1972713253
  NPD (past)
• L&M Physician Association, Inc

  • Family Medicine Physician
  • Ledyard, CT
  • NPI 1386972693

  Cardiovascular Disease

  NPD (past)
• North County Health Project Inc

  dba TrueCare

  • Federally Qualified Health Center (FQHC)
  • Ramona, CA
  • NPI 1073529681
  NPD (past)

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708041600000",
    "number": "1285676353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "196 PARKWAY SOUTH",
            "address_2": "SUITE 103",
            "city": "WATERFORD",
            "state": "CT",
            "postal_code": "06385",
            "telephone_number": "860-443-4383",
            "fax_number": "860-443-3980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "196 PARKWAY SOUTH",
            "address_2": "SUITE 103",
            "city": "WATERFORD",
            "state": "CT",
            "postal_code": "06385",
            "telephone_number": "860-443-4383",
            "fax_number": "860-443-3980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUPIS",
        "first_name": "ROBERT",
        "middle_name": "JOHN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2024-02-16",
        "certification_date": "2024-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CT",
            "license": "893",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "000893",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "58266",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMUNITY HEALTH NETWORK",
            "identifier": "06-1616101",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD/ECCD: 06-1616101",
            "identifier": "P2626854",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD/ECCG: 06-1049086",
            "identifier": "P2650601",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMUNITY HEALTH NETWORK",
            "identifier": "06-1049086",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET/ECCD:06-1616101",
            "identifier": "0V9727",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM/ECCD:06-1616101",
            "identifier": "290001019CT03",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM/HOSP-BASED ECCD",
            "identifier": "500HBC444CT01",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECARE FAMILY PLAN",
            "identifier": "004210407",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET/ECCG:06-1049086",
            "identifier": "0V9726",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MED/ECCD: 06-1616101",
            "identifier": "060064824",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM/ECCG:06-1049086",
            "identifier": "290000893CT01",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONNECTICARE",
            "identifier": "641664",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MED/ECCG: 06-1049086",
            "identifier": "970011351",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kacie Lee Klee
• Kurt E Klopfenstein
• Damianos Kokkinidis, M.D
• Laura Koziatek, RPT
• John R Kozlowski, DDS
• Aubrey J Kurtzman, M.S., ATC, LAT
• L&M Home Medical Equipment, LLC
• Michelle Renee La Forte, ATC
• Jacqueline Lagasse, MSN, NP-C
• Haleemah Lake, LCSW

• Physician Assistant in Waterford, CT
• Providers in Waterford, CT by specialty
• Physician Assistant in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.