NPIMap

Organization Active NPI

OBGYN Group of Eastern Connecticut, P.C.

  • Obstetrics & Gynecology Physician
  • South Windsor, CT
National Provider Identifier
1376756908
Registry record updated Jan 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
OBGYN GROUP OF EASTERN CONNECTICUT, P.C.
Practice address
2600 Tamarack Avenue
Suite 200
South Windsor, CT 06074-5560
Phone
(860) 646-1157
Fax
(860) 646-9877
NPI assigned
May 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2020

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

Authorized official

Name
Kelly Riccitelli
Title
Administrator
Phone
(860) 646-1157

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207V00000X Primary

Addresses

Primary practice location

2600 Tamarack Avenue
Suite 200
South Windsor, CT 06074-5560

Mailing address

2600 Tamarack Avenue
Suite 200
South Windsor, CT 06074-5560
Phone (860) 646-1157

Other identifiers 1

IdentifierTypeStateIssuer
004394251MedicaidCT

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040305000770 CT Part B Supplier - Clinic/Group Practice 2769370352 Receives reassigned benefits from 14 practitioners
Practice locations: Glastonbury, CT; South Windsor, CT

National Provider Directory

National Provider Directory

Locations

175 West Rd
Ellington, CT 06029
Phone (860) 375-5141

622 Hebron Ave
Ste 104A
Glastonbury, CT 06033
Phone (860) 646-1157

360 Tolland Tpke
Ste 3B
Manchester, CT 06042
Phone (860) 643-2731

2600 Tamarack Ave
#200
South Windsor, CT 06074
Phone (860) 646-1157

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1178582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579651200000",
    "number": "1376756908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 TAMARACK AVENUE",
            "address_2": "SUITE 200",
            "city": "SOUTH WINDSOR",
            "state": "CT",
            "postal_code": "060745560",
            "telephone_number": "860-646-1157",
            "fax_number": "860-646-9877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 TAMARACK AVENUE",
            "address_2": "SUITE 200",
            "city": "SOUTH WINDSOR",
            "state": "CT",
            "postal_code": "060745560",
            "telephone_number": "860-646-1157",
            "fax_number": "860-646-9877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OBGYN GROUP OF EASTERN CONNECTICUT, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-08",
        "last_updated": "2020-01-22",
        "certification_date": "2020-01-22",
        "status": "A",
        "authorized_official_last_name": "RICCITELLI",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "860-646-1157"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004394251",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Windsor, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.