NPIMap

Organization Active NPI

Center for Vein Restoration CT LLC

  • Vascular Surgery Physician
  • Stamford, CT
National Provider Identifier
1306282926
Registry record updated Apr 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
Legal business name
CENTER FOR VEIN RESTORATION CT LLC
Practice address
1290 Summer St
Suite 2100
Stamford, CT 06905-5360
Phone
(240) 965-3271
Fax
(240) 473-4321
NPI assigned
May 22, 2013
Last updated
Apr 30, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2024

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

Authorized official

Name
Khanh Q Khanh, MD
Title
Chief Medical Officer
Phone
(855) 830-8346

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Vascular Surgery Physician 2086S0129X NU Primary

Addresses

Primary practice location

1290 Summer St
Suite 2100
Stamford, CT 06905-5360

Mailing address

7474 Greenway Center Dr
Suite 1000
Greenbelt, MD 20770-3504
Phone (240) 965-3271

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130916000084 CT Part B Supplier - Clinic/Group Practice 8820232713 Receives reassigned benefits from 11 practitioners
Practice locations: Glastonbury, CT; Waterbury, CT; Stamford, CT; South Windsor, CT; Norwalk, CT; Middletown, CT; Enfield, CT; Cromwell, CT…
O20190523001379 CT DME Supplier - Physician - Thoracic Surgery 8820232713 Practice locations: Bloomfield, CT

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 29

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1369180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714435200000",
    "number": "1306282926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7474 GREENWAY CENTER DR",
            "address_2": "SUITE 1000",
            "city": "GREENBELT",
            "state": "MD",
            "postal_code": "207703504",
            "telephone_number": "240-965-3271",
            "fax_number": "240-473-4321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1290 SUMMER ST",
            "address_2": "SUITE 2100",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069055360",
            "telephone_number": "240-965-3271",
            "fax_number": "240-473-4321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR VEIN RESTORATION CT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-22",
        "last_updated": "2024-04-30",
        "certification_date": "2024-04-30",
        "status": "A",
        "authorized_official_last_name": "KHANH",
        "authorized_official_first_name": "KHANH",
        "authorized_official_middle_name": "Q",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "855-830-8346",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stamford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.