NPIMap

Organization Active NPI

Shoreline Audiology, LLC

  • Audiologist
  • Waterford, CT
National Provider Identifier
1336343243
Registry record updated Nov 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
070 Issued in CT
Legal business name
SHORELINE AUDIOLOGY, LLC
Practice address
167 Parkway N
Waterford, CT 06385-1200
Phone
(860) 739-5670
Fax
(860) 442-7906
NPI assigned
Jun 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2022

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

Authorized official

Name
Mr. Jeffrey W Worgul, M.S.NPI 1104964360
Title
President
Phone
(860) 443-6944

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
AudiologistGroup: 193200000X MULTI-SPECIALTY GROUP 231H00000X 070 CT Primary
Assistive Technology Practitioner AudiologistGroup: 193200000X MULTI-SPECIALTY GROUP 231HA2400X 070 CT
Assistive Technology Supplier AudiologistGroup: 193200000X MULTI-SPECIALTY GROUP 231HA2500X 070 CT
Audiologist-Hearing Aid FitterGroup: 193200000X MULTI-SPECIALTY GROUP 237600000X 070 CT

Addresses

Primary practice location

167 Parkway N
Waterford, CT 06385-1200

Mailing address

167 Parkway N
Waterford, CT 06385-1200
Phone (860) 739-5670

Other names 1

  • County Hearing and Balance Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070907000371 CT Part B Supplier - Clinic/Group Practice 0446343461 Receives reassigned benefits from 4 practitioners
Practice locations: Groton, CT; Madison, CT; Middletown, CT; Norwich, CT; Old Saybrook, CT; Waterford, CT

National Provider Directory

National Provider Directory

Locations

198 S Main St
Middletown, CT 06457
Phone (860) 301-9984

83 Halls Rd
Old Lyme, CT 06371
Phone (860) 227-7311

900 Boston Post Rd
Old Saybrook, CT 06475
Phone (860) 388-0022

167 Waterford Parkway N
Waterford, CT 06385
Phone (800) 443-6944

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1181692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667347200000",
    "number": "1336343243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "167 PARKWAY N",
            "city": "WATERFORD",
            "state": "CT",
            "postal_code": "063851200",
            "telephone_number": "860-739-5670",
            "fax_number": "860-442-7906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "167 PARKWAY N",
            "city": "WATERFORD",
            "state": "CT",
            "postal_code": "063851200",
            "telephone_number": "860-739-5670",
            "fax_number": "860-442-7906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORELINE AUDIOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-13",
        "last_updated": "2022-11-02",
        "certification_date": "2022-11-02",
        "status": "A",
        "authorized_official_last_name": "WORGUL",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "860-443-6944",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.S."
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Audiologist",
            "state": "CT",
            "license": "070",
            "primary": true
        },
        {
            "code": "231HA2400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Audiologist, Assistive Technology Practitioner",
            "state": "CT",
            "license": "070",
            "primary": false
        },
        {
            "code": "231HA2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Audiologist, Assistive Technology Supplier",
            "state": "CT",
            "license": "070",
            "primary": false
        },
        {
            "code": "237600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": "CT",
            "license": "070",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "County Hearing and Balance",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "County Hearing and Balance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Nov 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.