Active NPI
Connie Anjoli Desarden, M.D.
- Internal Medicine Physician
- Wauwatosa, WI
National Provider Identifier
1306100227
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 67984
- Practice address
- 3289 N Mayfair Rd
Wauwatosa, WI 53222-3203 - Phone
- (414) 771-7900
- Fax
- (414) 607-6336
- NPI assigned
- Jun 26, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 67984 | WI | Primary |
Addresses
Primary practice location
3289 N Mayfair Rd
Wauwatosa, WI 53222-3203
Mailing address
3289 N Mayfair Rd
Wauwatosa, WI 53222-3203
Phone (414) 771-7900
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | CONNIE.DESARDEN@hca3.eclinicaldirectplus.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jul 3, 2023 through Jul 3, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 67984 | WI | MD | Internal Medicine Physician |
Interoperability endpoints
- connie.desarden@hca3.eclinicaldirectplus.com
- connie.desarden.1@28781.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1643673600000",
"number": "1306100227",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3289 N MAYFAIR RD",
"city": "WAUWATOSA",
"state": "WI",
"postal_code": "532223203",
"telephone_number": "414-771-7900",
"fax_number": "414-607-6336"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3289 N MAYFAIR RD",
"city": "WAUWATOSA",
"state": "WI",
"postal_code": "532223203",
"telephone_number": "414-771-7900",
"fax_number": "414-607-6336"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DESARDEN",
"first_name": "CONNIE",
"middle_name": "ANJOLI",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-06-26",
"last_updated": "2022-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "WI",
"license": "67984",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "CONNIE.DESARDEN@hca3.eclinicaldirectplus.com",
"affiliation": "N",
"address_1": "3289 N Mayfair Rd",
"city": "Wauwatosa",
"state": "WI",
"country_code": "US",
"postal_code": "532223203",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Wauwatosa, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2022; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.