Gayelan Tietje-Ulrich, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

13390 Issued in CT

Practice address

675 Main St
Middletown, CT 06457-2732

Phone

(860) 347-6971

NPI assigned

May 15, 2024

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Community Health Center IncGroup PAC ID 0547169138, 149 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Saint Mary's Hospital Hospital, Waterbury, CT, CCN 070016
• Middlesex Hospital Hospital, Middletown, CT, CCN 070020

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Middletown, CT
  • NPI 1952591851
  Medicare reassignment Care Compare group NPD
• Community Health Center Inc

  dba City of Danbury Emergency Shelter WYA

  • Federally Qualified Health Center (FQHC)
  • Danbury, CT
  • NPI 1003332446
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Middlesex Hospital

  • General Acute Care Hospital
  • Middletown, CT
  • NPI 1760454334
  Care Compare affiliation
• Saint Mary's Hospital, Inc.

  • General Acute Care Hospital
  • Waterbury, CT
  • NPI 1760426969
  Care Compare affiliation

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

{
    "created_epoch": "1715731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719446400000",
    "number": "1477302263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 GRAND ST",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064572705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 MAIN ST",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064572732",
            "telephone_number": "860-347-6971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIETJE-ULRICH",
        "first_name": "GAYELAN",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "U",
        "enumeration_date": "2024-05-15",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CT",
            "license": "196793",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "13390",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thrive Therapy, LLC
• Terry S Thurrott, PA
• Janet Tibbetts, APRN
• Kathryn Merry Tiedy, M.S., CCC-A
• Kathryn W Tierney, APRN
• David Tillinghast, M.D.
• Donald D Timmerman
• Cynthia Tine, PTA
• Piper S Tobler, RD
• Christian Todzia

• Family Nurse Practitioner in Middletown, CT
• Providers in Middletown, CT by specialty
• Family Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.