NPIMap

Individual provider Active NPI

David Tkeshelashvili, M.D.

  • Neurology Physician
  • Waterbury, CT
National Provider Identifier
1306878731
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
036113 Issued in CT
Practice address
60 Westwood Ave
Suite320
Waterbury, CT 06708-2460
Phone
(203) 756-8995
Fax
(203) 756-4041
NPI assigned
Jul 7, 2006
Sex
Male
Sole proprietor
Yes

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
Neurology Physician 2084N0400X 036113 CT Primary

Addresses

Primary practice location

60 Westwood Ave
Suite320
Waterbury, CT 06708-2460

Mailing address

60 Westwood Ave
Suite320
Waterbury, CT 06708-2460
Phone (203) 756-8995

Other identifiers 1

IdentifierTypeStateIssuer
1361138MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050721000847 CT Practitioner - NeurologyPractitioner - Nephrology 8527095488 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Hartford Healthcare Medical Group Specialists PLLCGroup PAC ID 3173866241, 1,555 clinicians

Practice addresses (Care Compare)

455 Lewis Ave
Meriden, CT 06451-2121
Phone (203) 694-7595

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.42 of 100Reported as group
Quality
83.36
Promoting interoperability
100
Improvement activities
40
Cost
75.9

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
028460CTMDNeurology Physician
036113CTMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Charlotte Hungerford Hospital CurrentSince Jul 6, 2015 Accepting new patients
The Charlotte Hungerford Hospital Neurology CurrentSince Jul 6, 2015 Accepting new patients
Hartford Healthcare Medical Group, Inc Neurology CurrentSince Aug 1, 2017 Accepting new patients
Neighborhood Health, Inc. CurrentSince Jan 1, 2020 Accepting new patients
Hartford Healthcare Medical Group Specialists LLC CurrentSince Jun 1, 2019 Accepting new patients
Prospect Waterbury, Inc. CurrentSince Oct 1, 2016 Accepting new patients
Hartford Healthcare Medical Group Specialists, PLLC Neurology CurrentSince Jun 1, 2019 Accepting new patients

Locations

2800 Main St
Bridgeport, CT 06606
Phone (203) 386-0366

2660 Main St
Ste 210
Bridgeport, CT 06606
Phone (203) 334-2246

280 S Main St
Ste 204
Cheshire, CT 06410
Phone (203) 224-5161

455 Lewis Ave
Ste 221
Meriden, CT 06451
Phone (203) 694-7595

55 Meriden Ave
Ste 1D
Southington, CT 06489
Phone (860) 276-5144

1244 Storrs Rd
Storrs Mansfield, CT 06268
Phone (860) 724-2579

780 Litchfield St
Torrington, CT 06790
Phone (860) 350-9000

540 Litchfield St
Torrington, CT 06790
Phone (860) 496-6361

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

Interoperability endpoints

  • Direct secure messaging: david.tkeshelashvili@xdr.hhchealthdirect.org

Organizations & group practices 7

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.

Hospital & facility affiliations 10

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": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1306878731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 WESTWOOD AVE",
            "address_2": "SUITE320",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067082460",
            "telephone_number": "203-756-8995",
            "fax_number": "203-756-4041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 WESTWOOD AVE",
            "address_2": "SUITE320",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067082460",
            "telephone_number": "203-756-8995",
            "fax_number": "203-756-4041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TKESHELASHVILI",
        "first_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CT",
            "license": "036113",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1361138",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterbury, CT

Sources for this page

Verify at the official NPI Registry.