NPIMap

Organization Active NPI

Norwich Ophthalmology Group, P.C.

  • Ophthalmology Physician
  • Norwich, CT
National Provider Identifier
1447438924
Registry record updated Jan 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
NORWICH OPHTHALMOLOGY GROUP, P.C.
Practice address
79 Wawecus St
Suite 105
Norwich, CT 06360-2160
Phone
(860) 886-0161
Fax
(860) 889-5999
NPI assigned
Feb 6, 2008
Last updated
Jan 26, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2021

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

Authorized official

Name
Dr. Anish U Shah, MDNPI 1528092657
Title
President
Phone
(860) 886-0161

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207W00000X Primary
Eyewear Supplier 332H00000X

Addresses

Primary practice location

79 Wawecus St
Suite 105
Norwich, CT 06360-2160

Mailing address

79 Wawecus St
Suite 105
Norwich, CT 06360-2160
Phone (860) 886-0161

Other identifiers 1

IdentifierTypeStateIssuer
004394623MedicaidCT

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040820000013 CT Part B Supplier - Clinic/Group Practice 8820062508 Receives reassigned benefits from 8 practitioners
Practice locations: Niantic, CT; Norwich, CT; Groton, CT

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
07D2059287Norwich Ophthalmology Group, PC79 Wawecus St, Suite 105, Norwich, CT 06360Certificate of waiverMay 20, 2027

National Provider Directory

National Provider Directory

Locations

179 Flanders Rd
Niantic, CT 06357
Phone (860) 437-2341

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1202256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611619200000",
    "number": "1447438924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "79 WAWECUS ST",
            "address_2": "SUITE 105",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063602160",
            "telephone_number": "860-886-0161",
            "fax_number": "860-889-5999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "79 WAWECUS ST",
            "address_2": "SUITE 105",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063602160",
            "telephone_number": "860-886-0161",
            "fax_number": "860-889-5999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORWICH OPHTHALMOLOGY GROUP, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-06",
        "last_updated": "2021-01-26",
        "certification_date": "2021-01-25",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "ANISH",
        "authorized_official_middle_name": "U",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "860-886-0161",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004394623",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Norwich, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.