Individual provider Active NPI

Marvela Gratia Hermanus, DPM

  • Podiatrist
  • Wallingford, CT
National Provider Identifier
1467466995
Registry record updated May 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
2209 Issued in MA
Practice address
850 N Main Street Ext Ste 2A2
Wallingford, CT 06492-2483
Phone
(203) 626-5581
NPI assigned
Jul 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Podiatrist 213E00000X DPM00314 RI
Podiatrist 213E00000X 2209 MA Primary

Addresses

Primary practice location

850 N Main Street Ext Ste 2A2
Wallingford, CT 06492-2483

Mailing address

888 Worcester St
Suite 130
Wellesley, MA 02482-3744
Phone (617) 964-6681

Other practice location 1

888 Worcester St
Suite 130
Wellesley, MA 02482-3744
Phone (617) 964-6681

Other identifiers 5

IdentifierTypeStateIssuer
29310-1/412354OtherRIBLUE CROSS BLUE SHIELD
480031933OtherMEDICARE RAILROAD
0322016MedicaidMA
MH48662MedicaidRI
Y71109OtherMABLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT, RI2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040601001225 CT Practitioner - Podiatry 9830089572 Reassigns benefits to 1 organization
Practice locations: Wallingford, CT
I20100202000762 RI Practitioner - Podiatry 9830089572 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
New York College of Podiatric Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Connecticut Podiatry Partners, PLLCGroup PAC ID 6901228063, 6 clinicians

Practice addresses (Care Compare)

30 Sayles Hill Rd
Manville, RI 02838-1227
Phone (203) 626-5581

850 N Main St Ext
Suite 2A2
Wallingford, CT 06492-2483
Phone (203) 314-9493

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1806
Removal or shaving of skin growth212

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2209MAMDPsychologist
000746CTMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Carelink, Inc. Current Accepting new patients
Connecticut Podiatry Partners, PLLC Podiatrist CurrentSince May 1, 2025 Accepting new patients

Locations

850 N Main Street Ext
Ste 2A2
Wallingford, CT 06492
Phone (203) 314-9493

400 Massasoit Ave
Ste 113
East Providence, RI 02914
Phone (401) 490-4610

400 Massasoit Ave
Ste 300B
East Providence, RI 02914

30 Sayles Hill Rd
Manville, RI 02838
Phone (203) 626-5581

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/AEBJDD

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.

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778803200000",
    "number": "1467466995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "888 WORCESTER ST",
            "address_2": "SUITE 130",
            "city": "WELLESLEY",
            "state": "MA",
            "postal_code": "024823744",
            "telephone_number": "617-964-6681",
            "fax_number": "339-686-2561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 N MAIN STREET EXT STE 2A2",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064922483",
            "telephone_number": "203-626-5581"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "888 Worcester St",
            "address_2": "Suite 130",
            "address_purpose": "LOCATION",
            "city": "Wellesley",
            "state": "MA",
            "postal_code": "024823744",
            "country_code": "US",
            "telephone_number": "617-964-6681",
            "fax_number": "339-686-2561",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HERMANUS",
        "first_name": "MARVELA",
        "middle_name": "GRATIA",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-28",
        "last_updated": "2026-05-15",
        "certification_date": "2026-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "RI",
            "license": "DPM00314",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "MA",
            "license": "2209",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "29310-1/412354",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "480031933",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0322016",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MH48662",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "Y71109",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wallingford, CT

Sources for this page

Verify at the official NPI Registry.