Active NPI
Radhika Abhishek Agrawal, M.D.
- Pediatrics Physician
- Waterbury, CT
National Provider Identifier
1285918979
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 052533
- Practice address
- 80 Phoenix Ave
Suite 201
Waterbury, CT 06702-1418 - Phone
- (203) 756-8021
- Fax
- (203) 596-9038
- NPI assigned
- Sep 29, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatrics Physician | 208000000X | 052533 | CT | Primary |
Addresses
Primary practice location
80 Phoenix Ave
Suite 201
Waterbury, CT 06702-1418
Mailing address
80 Phoenix Ave
Suite 201
Waterbury, CT 06702-1418
Phone (203) 756-8021
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 008041736 | Medicaid | CT |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20141204000104 | CT | Practitioner - Pediatric Medicine | 3870815772 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 052533 | CT | MD | Pediatrics Physician |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1438214400000",
"number": "1285918979",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "80 PHOENIX AVE",
"address_2": "SUITE 201",
"city": "WATERBURY",
"state": "CT",
"postal_code": "067021418",
"telephone_number": "203-756-8021",
"fax_number": "203-596-9038"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "80 PHOENIX AVE",
"address_2": "SUITE 201",
"city": "WATERBURY",
"state": "CT",
"postal_code": "067021418",
"telephone_number": "203-756-8021",
"fax_number": "203-596-9038"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AGRAWAL",
"first_name": "RADHIKA",
"middle_name": "ABHISHEK",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-09-29",
"last_updated": "2015-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CT",
"license": "052533",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "008041736",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waterbury, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2015; 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.