Active NPI
Retina Group of New England PC
- Retina Specialist (Ophthalmology) Physician
- Waterford, CT
National Provider Identifier
1316329733
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Retina Specialist (Ophthalmology) Physician
- Legal business name
- RETINA GROUP OF NEW ENGLAND PC
- Practice address
- 174 Cross Rd
Waterford, CT 06385-1215 - Phone
- (860) 444-1292
- Fax
- (860) 444-1827
- NPI assigned
- Jun 22, 2015
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Sunni Surawski
- Title
- Practice Admin
- Phone
- (860) 444-1292
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Retina Specialist (Ophthalmology) Physician | 207WX0107X | Primary |
Addresses
Primary practice location
174 Cross Rd
Waterford, CT 06385-1215
Mailing address
174 Cross Rd
Waterford, CT 06385-1215
Phone (860) 444-1292
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004182789 | Medicaid | CT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
Enrollment records 1
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 07D1068724 | Retina Group of New England, PC | Certificate of waiver | May 17, 2027 |
National Provider Directory
National Provider DirectoryLocations
5 Durham Rd
Ste A6
Guilford, CT 06437
79 Wawecus St
Ste 109
Norwich, CT 06360
Phone (860) 887-3538
1190 Silas Deane Hwy
Wethersfield, CT 06109
Interoperability endpoints
- ayazdanyar@rgne.intellechartdirect.net
- nchaudhry@rgne.intellechartdirect.net
Practitioners & affiliated clinicians
Practitioners 4
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Retina Specialist (Ophthalmology) Physician
- Waterford, CT
- NPI 1770513715
-
- Retina Specialist (Ophthalmology) Physician
- Waterford, CT
- NPI 1457510687
-
- Retina Specialist (Ophthalmology) Physician
- Waterford, CT
- NPI 1811332083
-
- Retina Specialist (Ophthalmology) Physician
- Waterford, CT
- NPI 1528929403
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1434931200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1600732800000",
"number": "1316329733",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "174 CROSS RD",
"city": "WATERFORD",
"state": "CT",
"postal_code": "063851215",
"telephone_number": "860-444-1292",
"fax_number": "860-444-1827"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "174 CROSS RD",
"city": "WATERFORD",
"state": "CT",
"postal_code": "063851215",
"telephone_number": "860-444-1292",
"fax_number": "860-444-1827"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "RETINA GROUP OF NEW ENGLAND PC",
"organizational_subpart": "NO",
"enumeration_date": "2015-06-22",
"last_updated": "2020-09-22",
"certification_date": "2020-09-22",
"status": "A",
"authorized_official_last_name": "SURAWSKI",
"authorized_official_first_name": "SUNNI",
"authorized_official_title_or_position": "PRACTICE ADMIN",
"authorized_official_telephone_number": "860-444-1292"
},
"taxonomies": [
{
"code": "207WX0107X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Ophthalmology, Retina Specialist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004182789",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Waterford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2020; 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.