Active NPI
M. Amy Jagoda, AUDIOLOGIST
- Audiologist
- Waterbury, CT
National Provider Identifier
1457517252
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- 000411
- Practice address
- 22 Tompkins St
Waterbury, CT 06708 - Phone
- (203) 754-5141
- Fax
- (203) 236-0181
- NPI assigned
- Jul 31, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | |||
| Audiologist-Hearing Aid Fitter | 237600000X | |||
| Audiologist | 231H00000X | 000411 | CT | Primary |
Addresses
Primary practice location
22 Tompkins St
Waterbury, CT 06708
Mailing address
22 Tompkins St
Waterbury, CT 06708-1496
Phone (203) 754-5141
Other practice location 1
Gaylord Farm Rd
Wallingford, CT 06492
Phone (203) 284-2800
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000411 | CT | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Radiologic Associates of Middletown PC | Past | Accepting new patients | |
| Gaylord Hospital, Inc. | Past | Accepting new patients |
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.
-
- Long Term Care Hospital
- Wallingford, CT
- NPI 1730137753
-
- Diagnostic Radiology Physician
- Middletown, CT
- NPI 1124137328
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1217462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554076800000",
"number": "1457517252",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22 TOMPKINS ST",
"city": "WATERBURY",
"state": "CT",
"postal_code": "067081496",
"telephone_number": "203-754-5141",
"fax_number": "203-236-0181"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22 TOMPKINS ST",
"city": "WATERBURY",
"state": "CT",
"postal_code": "06708",
"telephone_number": "203-754-5141",
"fax_number": "203-236-0181"
}
],
"practiceLocations": [
{
"address_1": "Gaylord Farm Rd",
"address_purpose": "LOCATION",
"city": "Wallingford",
"state": "CT",
"postal_code": "06492",
"country_code": "US",
"telephone_number": "203-284-2800",
"fax_number": "203-294-3294",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JAGODA",
"first_name": "M. AMY",
"credential": "AUDIOLOGIST",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-07-31",
"last_updated": "2019-04-01",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": null,
"license": null,
"primary": false
},
{
"code": "237600000X",
"taxonomy_group": "",
"desc": "Audiologist-Hearing Aid Fitter",
"state": null,
"license": null,
"primary": false
},
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "CT",
"license": "000411",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waterbury, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.