Individual provider Active NPI

David Klimowicz, P.A.-C.

  • Surgical Physician Assistant
  • Manchester, CT
National Provider Identifier
1356584718
Registry record updated Apr 15, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
002252 Issued in CT
Practice address
71 Haynes St
Manchester, CT 06040-4131
Phone
(860) 646-1222
NPI assigned
Apr 15, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 15, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 002252 CT Primary

Addresses

Primary practice location

71 Haynes St
Manchester, CT 06040-4131

Mailing address

211 Pomeroy Ave
Apartment # 2205
Meriden, CT 06450-7165
Phone (716) 560-4195

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090911000218 CT Practitioner - Physician Assistant 3577618701 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hartford Healthcare Medical Group Specialists PLLCGroup PAC ID 3173866241, 1,555 clinicians
Prospect CT Medical Foundation IncGroup PAC ID 7416244496, 287 clinicians

Practice addresses (Care Compare)

1244 Storrs Rd
Road
Storrs, CT 06268-2200
Phone (860) 724-2579

18 Haynes St
Uppr Level
Manchester, CT 06040-4111
Phone (860) 649-7557

71 Haynes St
Manchester, CT 06040-4131
Phone (860) 647-6800

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
002252CTMDSurgical Physician Assistant

Organizations & group practices 2

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 1

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": "1239753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1239753600000",
    "number": "1356584718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 POMEROY AVE",
            "address_2": "APARTMENT # 2205",
            "city": "MERIDEN",
            "state": "CT",
            "postal_code": "064507165",
            "telephone_number": "716-560-4195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "71 HAYNES ST",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060404131",
            "telephone_number": "860-646-1222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLIMOWICZ",
        "first_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "P.A.-C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-04-15",
        "last_updated": "2009-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CT",
            "license": "002252",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, CT

Sources for this page

Verify at the official NPI Registry.