NPIMap

Organization Active NPI

Child & Adolescent Health Care

  • Pediatrics Physician
  • Waterbury, CT
National Provider Identifier
1497937411
Registry record updated Mar 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
000431 Issued in CT
Legal business name
CHILD & ADOLESCENT HEALTH CARE
Practice address
179 Roseland Ave
Waterbury, CT 06710
Phone
(203) 574-4747
Fax
(203) 574-2251
NPI assigned
Nov 30, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2012

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

Authorized official

Name
Jane Rudolph, MDNPI 1639189707
Title
Owner
Phone
(203) 574-4747

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X 000431 CT Primary

Addresses

Primary practice location

179 Roseland Ave
Waterbury, CT 06710

Mailing address

179 Roseland Ave
Waterbury, CT 06710
Phone (203) 574-4747

Other identifiers 1

IdentifierTypeStateIssuer
4049987MedicaidCT

National Provider Directory

National Provider Directory

Locations

179 Roseland Ave
Waterbury, CT 06710
Phone (203) 574-4747

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/11240/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 11

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": "1196380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333065600000",
    "number": "1497937411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "179 ROSELAND AVE",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "06710",
            "telephone_number": "203-574-4747",
            "fax_number": "203-574-2251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "179 ROSELAND AVE",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "06710",
            "telephone_number": "203-574-4747",
            "fax_number": "203-574-2251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILD & ADOLESCENT HEALTH CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-30",
        "last_updated": "2012-03-30",
        "status": "A",
        "authorized_official_last_name": "RUDOLPH",
        "authorized_official_first_name": "JANE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-574-4747",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "CT",
            "license": "000431",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4049987",
            "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 Mar 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.