Individual provider Active NPI

Maria Bolastig, M.D.,

  • Anesthesiology Physician
  • Waterbury, CT
National Provider Identifier
1295756203
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
039849 Issued in CT
Practice address
140 Grandview Ave
Waterbury, CT 06708-2505
Phone
(203) 757-7000
NPI assigned
Jul 22, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 039849 CT Primary

Addresses

Primary practice location

140 Grandview Ave
Waterbury, CT 06708-2505

Mailing address

58 Old Towne Rd
Cheshire, CT 06410-3134

Other identifiers 1

IdentifierTypeStateIssuer
1398496MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT, NY2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20110510000176 CT Practitioner - Anesthesiology 6608052675 Reassigns benefits to 2 organizations
I20201221000482 NY Practitioner - Anesthesiology 6608052675 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mary Imogene Bassett HospitalGroup PAC ID 3779488325, 780 clinicians

Practice addresses (Care Compare)

1 Atwell Rd
Cooperstown, NY 13326-1301
Phone (607) 547-3480

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.62 of 100Reported as apm
Quality
77.97
Promoting interoperability
98
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
902WYMDDentist
039849CTMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Connecticut Gi PLLC CurrentSince Jul 1, 2020 Accepting new patients
Mary Imogene Bassett Hospital CurrentSince Nov 30, 2020 Accepting new patients
Mary Imogene Bassett Hospital CurrentSince Nov 30, 2020 Accepting new patients
North American Partners in Anesthesia Connecticut PC Anesthesiology CurrentSince Aug 4, 2019 Accepting new patients

Locations

85 Seymour St
Ste 1000
Hartford, CT 06106
Phone (860) 246-2571

100 Grand St
New Britain, CT 06052
Phone (860) 224-5011

30 Waterchase Dr
Rocky Hill, CT 06067
Phone (860) 257-4131

1312 W Main St
Ste 101
Waterbury, CT 06708
Phone (203) 346-2200

64 Robbins St
Waterbury, CT 06708
Phone (203) 573-7142

178 Grandview Dr
Cobleskill, NY 12043
Phone (518) 254-3456

1 Atwell Rd
Cooperstown, NY 13326
Phone (607) 547-3480

460 Andes Rd
Delhi, NY 13753
Phone (607) 746-0300

130 North St
Walton, NY 13856
Phone (607) 865-6541

Organizations & group practices 4

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1295756203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "58 OLD TOWNE RD",
            "city": "CHESHIRE",
            "state": "CT",
            "postal_code": "064103134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 GRANDVIEW AVE",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067082505",
            "telephone_number": "203-757-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLASTIG",
        "first_name": "MARIA",
        "credential": "M.D.,",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CT",
            "license": "039849",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1398496",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterbury, CT

Sources for this page

Verify at the official NPI Registry.