Organization Active NPI

Retina Group of New England PC

  • Retina Specialist (Ophthalmology) Physician
  • Waterford, CT
National Provider Identifier
1316329733
Registry record updated Sep 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X
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

Updated by the provider on Sep 22, 2020

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)CodeLicenseStatePrimary
Retina Specialist (Ophthalmology) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 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

IdentifierTypeStateIssuer
004182789MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151013000759 CT Part B Supplier - Clinic/Group Practice 8921317090 Receives reassigned benefits from 3 practitioners
Practice locations: Waterford, CT

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
07D1068724Retina Group of New England, PC174 Cross Rd, Waterford, CT 06385Certificate of waiverMay 17, 2027

National Provider Directory

National Provider Directory

Locations

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

  • Direct secure messaging: ayazdanyar@rgne.intellechartdirect.net
  • Direct secure messaging: 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.

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.

Verify at the official NPI Registry.