NPIMap

Individual provider Active NPI

Surayda Julissa Herrera, D.O

  • Internal Medicine Physician
  • Willimantic, CT
National Provider Identifier
1497169700
Registry record updated May 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
TL.0005341 Issued in CO
Practice address
5 Founders St Ste 100
Willimantic, CT 06226-2049
Phone
(860) 423-9764
Fax
(860) 724-2580
NPI assigned
Jun 13, 2014
Last updated
May 22, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X TL.0005341 CO Primary

Addresses

Primary practice location

5 Founders St Ste 100
Willimantic, CT 06226-2049

Mailing address

457 Stanley Dr
Glastonbury, CT 06033-2623
Phone (516) 410-4367

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170925002162 CT Practitioner - Internal Medicine 9335368083 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
New York College of Osteo Medicine of New York Institute of Technology, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Hartford Healthcare Medical Group IncGroup PAC ID 1153573902, 257 clinicians

Practice addresses (Care Compare)

476 Cromwell Ave
Rocky Hill, CT 06067-1806
Phone (860) 714-4548

5 Founders Dr
Willimantic, CT 06226-2048
Phone (860) 423-9764

5 Founders St
Willimantic, CT 06226-2048
Phone (860) 423-5000

55 Meriden Ave
Suite 1D
Southington, CT 06489-3239
Phone (860) 276-5144

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.48 of 100Reported as apm
Quality
83.4
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
TL.0005341COMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Trinity Health of New England Provider Network Organization Inc Internal Medicine CurrentSince Mar 1, 2026 Accepting new patients
Hartford Healthcare Medical Group, Inc Internal Medicine CurrentSince Aug 21, 2017 Accepting new patients
Trinity Health of New England Provider Network Organization Inc Internal Medicine CurrentSince Mar 1, 2026 Accepting new patients

Locations

1000 Asylum Ave
Rm 1004
Hartford, CT 06105
Phone (860) 714-4532

114 Woodland St
Hartford, CT 06105
Phone (860) 714-4001

476 Cromwell Ave
Rocky Hill, CT 06067
Phone (860) 696-6400

55 Meriden Ave
Ste 1D
Southington, CT 06489
Phone (860) 276-5144

1290 Silas Deane Hwy
Wethersfield, CT 06109
Phone (860) 972-6977

5 Founders St
Ste 100
Willimantic, CT 06226
Phone (860) 423-9764

Interoperability endpoints

  • Direct secure messaging: surayda.herrera@xdr.hhchealthdirect.org

Organizations & group practices 3

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.

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1402617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716336000000",
    "number": "1497169700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "457 STANLEY DR",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060332623",
            "telephone_number": "516-410-4367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 FOUNDERS ST STE 100",
            "city": "WILLIMANTIC",
            "state": "CT",
            "postal_code": "062262049",
            "telephone_number": "860-423-9764",
            "fax_number": "860-724-2580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERRERA",
        "first_name": "SURAYDA",
        "middle_name": "JULISSA",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-13",
        "last_updated": "2024-05-22",
        "certification_date": "2024-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CO",
            "license": "TL.0005341",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Willimantic, CT

Sources for this page

Verify at the official NPI Registry.