OB-GYN Associates of West Hartford, PC

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

017368 Issued in CT

Legal business name

OB-GYN ASSOCIATES OF WEST HARTFORD, PC

Practice address

1 Northwestern Dr Ste 202
Bloomfield, CT 06002-3400

Phone

(860) 233-8589

Fax

(860) 236-9636

NPI assigned

Nov 1, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Jacquelyn Gustafson

Title

Practice Manager

Phone

(860) 233-8589

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/9252/brand/1/csg/1/fhir/r4

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609372800000",
    "number": "1447337050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 NORTHWESTERN DR STE 202",
            "city": "BLOOMFIELD",
            "state": "CT",
            "postal_code": "060023400",
            "telephone_number": "860-233-8589",
            "fax_number": "860-236-9636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 NORTHWESTERN DR STE 202",
            "city": "BLOOMFIELD",
            "state": "CT",
            "postal_code": "060023400",
            "telephone_number": "860-233-8589",
            "fax_number": "860-236-9636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OB-GYN ASSOCIATES OF WEST HARTFORD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2020-12-31",
        "certification_date": "2020-12-31",
        "status": "A",
        "authorized_official_last_name": "GUSTAFSON",
        "authorized_official_first_name": "JACQUELYN",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "860-233-8589",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "CT",
            "license": "017368",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA/US HEALTHCARE",
            "identifier": "0029111",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001173681",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "010017368CT01",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.