NPIMap

Organization Active NPI

Easter Seal Rehabilitation Center

  • Clinic/Center
  • Waterbury, CT
National Provider Identifier
1497054316
Registry record updated Jun 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
EASTER SEAL REHABILITATION CENTER
Practice address
22 Tompkins St
Waterbury, CT 06708-1496
Phone
(203) 754-5141
Fax
(203) 757-1198
NPI assigned
Mar 17, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2023

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

Authorized official

Name
Mr. Gary Nielsen
Title
Cfo/Coo
Phone
(203) 754-5141

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary
Hearing and Speech Clinic/Center 261QH0700X
Hearing Aid Equipment 332S00000X

Addresses

Primary practice location

22 Tompkins St
Waterbury, CT 06708-1496

Mailing address

22 Tompkins St
Waterbury, CT 06708-1496
Phone (203) 754-5141

Other identifiers 6

IdentifierTypeStateIssuer
12DME0601CT01OtherCTANTHEM BLUE CROSS BLUE SHIELD
232000OtherCONNECTICARE
017500OtherCTCONNECTICARE
5376280OtherAETNA
5617574OtherCTAETNA
800009105CT01OtherCTANTHEM BLUE CROSS BLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110623000397 CT Part B Supplier - Clinic/Group Practice 7416864178 Receives reassigned benefits from 5 practitioners
Practice locations: Southbury, CT; Waterbury, CT; Meriden, CT

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Easter Seal Rehab Audio4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1300320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687305600000",
    "number": "1497054316",
    "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": "203-757-1198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 TOMPKINS ST",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067081496",
            "telephone_number": "203-754-5141",
            "fax_number": "203-757-1198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTER SEAL REHABILITATION CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-17",
        "last_updated": "2023-06-21",
        "certification_date": "2023-06-21",
        "status": "A",
        "authorized_official_last_name": "NIELSEN",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "CFO/COO",
        "authorized_official_telephone_number": "203-754-5141",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QH0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Hearing and Speech",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332S00000X",
            "taxonomy_group": "",
            "desc": "Hearing Aid Equipment",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS BLUE SHIELD",
            "identifier": "12DME0601CT01",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONNECTICARE",
            "identifier": "232000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONNECTICARE",
            "identifier": "017500",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5376280",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5617574",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS BLUE SHIELD",
            "identifier": "800009105CT01",
            "state": "CT"
        }
    ],
    "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 Jun 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.