NPIMap

Individual provider Active NPI

Mary Rose Gotardo Tantoco, M.D.

  • Nephrology Physician
  • Uncasville, CT
National Provider Identifier
1336315969
Registry record updated Apr 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
62257 Issued in CT
Practice address
88 Norwich New London Tpke Ste 2
Uncasville, CT 06382-2518
Phone
(860) 367-0087
NPI assigned
May 4, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 62257 CT Primary

Addresses

Primary practice location

88 Norwich New London Tpke Ste 2
Uncasville, CT 06382-2518

Mailing address

88 Norwich New London Tpke Ste 2
Uncasville, CT 06382-2518
Phone (860) 367-0087

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
I20190307000921 CT Practitioner - Nephrology 3072747666 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1290 Silas Deane Hwy
Heartford Healthcare Cvo Pe
Wethersfield, CT 06360-2740

88 Norwick New London Turnpike
Suite 2
Uncasville, CT 06382

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Promoting interoperability
100
Improvement activities
40
Cost
77.47

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Southeastern CT Nephrology Assoc PC Nephrology CurrentSince Feb 1, 2019 Accepting new patients
William W Backus Hospital CurrentSince Oct 15, 2024 Accepting new patients
The William W Backus Hospital CurrentSince Oct 15, 2024 Accepting new patients
Southeastern CT Nephrology Assoc. PastSince Feb 1, 2019 Accepting new patients

Locations

326 Washington St
Norwich, CT 06360
Phone (860) 701-0140

88 Norwich New London Tpke
Ste 2
Uncasville, CT 06382
Phone (860) 367-0087

Interoperability endpoints

  • Direct secure messaging: mary.tantoco@xdr.hhchealthdirect.org
  • Direct secure messaging: mtantoco422070@direct.ynhh.org

Organizations & group practices 4

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 6

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": "1209859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554249600000",
    "number": "1336315969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "88 NORWICH NEW LONDON TPKE STE 2",
            "city": "UNCASVILLE",
            "state": "CT",
            "postal_code": "063822518",
            "telephone_number": "860-367-0087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "88 NORWICH NEW LONDON TPKE STE 2",
            "city": "UNCASVILLE",
            "state": "CT",
            "postal_code": "063822518",
            "telephone_number": "860-367-0087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANTOCO",
        "first_name": "MARY ROSE",
        "middle_name": "GOTARDO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-04",
        "last_updated": "2019-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CT",
            "license": "62257",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Uncasville, CT

Sources for this page

Verify at the official NPI Registry.