Elyse Kirschblum, MA CCC-A

Primary specialty

AudiologistTaxonomy code 231H00000X

License

000208 Issued in CT

Practice address

36 Watson St
Willimantic, CT 06226-2122

Phone

(860) 456-0287

Fax

(860) 456-3532

NPI assigned

Nov 30, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Specialty

Qualified Audiologist

Education

Other, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ear, Nose and Throat Associates of Worcester, Inc.Group PAC ID 7416024419, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

Practice roles

Locations

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.

• Ear, Nose & Throat Associates of Worcester, Inc.

  • Otolaryngology Physician
  • Charlton, MA
  • NPI 1285620609

  Audiologist, CT

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1519257600000",
    "number": "1316015464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "79 WAWECUS ST",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063602160",
            "telephone_number": "860-886-6610",
            "fax_number": "860-886-6664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36 WATSON ST",
            "city": "WILLIMANTIC",
            "state": "CT",
            "postal_code": "062262122",
            "telephone_number": "860-456-0287",
            "fax_number": "860-456-3532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIRSCHBLUM",
        "first_name": "ELYSE",
        "credential": "MA CCC-A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-30",
        "last_updated": "2018-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "237600000X",
            "taxonomy_group": "",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": "CT",
            "license": "000208",
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "CT",
            "license": "000208",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1316015464",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tiffany Kennedy
• Divya Mangala Kestur Rajasekhar, MD
• Archna Khattar, LMFT
• Michael A Kilgannon, M.D.
• Brian King, M.D.
• Steven E Knotts, CRNA
• Ajit J Kokkat, M.D.
• Jennifer Lynn Kollar, M.A.
• Jennifer M Koller
• Leszek A Kolodziejczak, MD

• Audiologist in Willimantic, CT
• Providers in Willimantic, CT by specialty
• Audiologist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.