Individual provider Active NPI

Robert James Wasnick, M.D.

  • Hospitalist Physician
  • Derby, CT
National Provider Identifier
1508057571
Registry record updated Oct 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
45748 Issued in CT
Practice address
130 Division St
Derby, CT 06418
Phone
(203) 732-1330
Fax
(203) 732-1332
NPI assigned
Aug 6, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 244083 NY
Hospitalist Physician 208M00000X 45748 CT Primary

Addresses

Primary practice location

130 Division St
Derby, CT 06418

Mailing address

67 Maple Ave
Derby, CT 06418-1328
Phone (203) 732-1330

Other practice location 1

21 Elm Street
New Milford, CT 06776
Phone (860) 355-2611

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071210000054 CT Practitioner - Internal Medicine 9739278060 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Jefferson Medical College of Thomas Jefferson University, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nuvance Health Medical Practice CT IncGroup PAC ID 4789597691, 742 clinicians

Practice addresses (Care Compare)

24 Hospital Ave
Danbury, CT 06810-6099
Phone (203) 739-7118

Hospital & facility affiliations

  • Danbury Hospital Hospital, Danbury, CT, CCN 070033

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
244083NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Griffin Faculty Physicians, Inc. Internal Medicine CurrentSince Jul 1, 2018 Accepting new patients
Nuvance Health Medical Practice CT, Inc. Internal Medicine CurrentSince Sep 1, 2011 Accepting new patients

Locations

24 Hospital Ave
Danbury, CT 06810
Phone (203) 739-7118

67 Maple Ave
Derby, CT 06418
Phone (203) 732-0699

130 Division St
Derby, CT 06418
Phone (203) 732-1330

21 Elm St
New Milford, CT 06776
Phone (860) 210-5000

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.

Hospital & facility affiliations 2

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": "1186358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539043200000",
    "number": "1508057571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 MAPLE AVE",
            "city": "DERBY",
            "state": "CT",
            "postal_code": "064181328",
            "telephone_number": "203-732-1330",
            "fax_number": "203-732-1332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 DIVISION ST",
            "city": "DERBY",
            "state": "CT",
            "postal_code": "06418",
            "telephone_number": "203-732-1330",
            "fax_number": "203-732-1332"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "21 Elm Street",
            "address_purpose": "LOCATION",
            "city": "New Milford",
            "state": "CT",
            "postal_code": "06776",
            "country_code": "US",
            "telephone_number": "860-355-2611",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WASNICK",
        "first_name": "ROBERT",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-06",
        "last_updated": "2018-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "244083",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "CT",
            "license": "45748",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Derby, CT

Sources for this page

Verify at the official NPI Registry.