NPIMap

Individual provider Active NPI

Amit Patel, DMD

  • General Practice Dentistry
  • Durham, CT
National Provider Identifier
1396746400
Registry record updated Dec 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
008838 Issued in CT
Practice address
28 Elihu Dr
Durham, CT 06422-1025
Phone
(203) 927-2104
NPI assigned
Aug 10, 2005
Last updated
Dec 13, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 008838 CT Primary

Addresses

Primary practice location

28 Elihu Dr
Durham, CT 06422-1025

Mailing address

28 Elihu Dr
Durham, CT 06422-1025
Phone (203) 927-2104

Other identifiers 1

IdentifierTypeStateIssuer
004235968MedicaidCT

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
I20031119000566 CT Practitioner - Oral SurgeryPractitioner - Dentist 1557275815 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
008838CTMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Staywell Health Care Inc PastSince Jan 1, 1990 Accepting new patients
Staywell Health Care Inc. PastSince Jan 1, 1990 Accepting new patients
Prospect Dental Past Accepting new patients
Staywell Health Care, Inc PastSince Jan 1, 1990 Accepting new patients
Staywell Healthcare, Inc PastSince Jan 1, 1990 Accepting new patients
Staywell Health Care, Inc. PastSince Jan 1, 1990 Accepting new patients
Staywell Health Care Inc PastSince Jan 1, 1990 Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.70969

Ownership & related parties

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Staywell Health CenterWaterbury, CT, CCN 071836 Federally qualified health center Corporate Director Sep 1, 2001
Staywell Health CenterWaterbury, CT, CCN 071826 Federally qualified health center Corporate Director May 16, 2013
Staywell Health CenterWaterbury, CT, CCN 071827 Federally qualified health center Corporate Director Sep 1, 2001
Staywell Heatlh CenterWaterbury, CT, CCN 071886 Federally qualified health center Corporate Director Sep 1, 2001
Staywell Health CenterWaterbury, CT, CCN 071908 Federally qualified health center Corporate Director Sep 1, 2001

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481587200000",
    "number": "1396746400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 ELIHU DR",
            "city": "DURHAM",
            "state": "CT",
            "postal_code": "064221025",
            "telephone_number": "203-927-2104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 ELIHU DR",
            "city": "DURHAM",
            "state": "CT",
            "postal_code": "064221025",
            "telephone_number": "203-927-2104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATEL",
        "first_name": "AMIT",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-10",
        "last_updated": "2016-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "008838",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004235968",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Durham, CT

Sources for this page

Verify at the official NPI Registry.