Individual provider Active NPI

Gunjan Sharma, MD

  • Internal Medicine Physician
  • Waterbury, CT
National Provider Identifier
1508875089
Registry record updated Mar 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
045175 Issued in CT
Practice address
80 Phoenix Ave
Suite 201
Waterbury, CT 06702-1418
Phone
(203) 756-8021
Fax
(203) 596-9038
NPI assigned
Aug 5, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2014

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 045175 CT Primary
Pediatrics Physician 208000000X 045175 CT

Addresses

Primary practice location

80 Phoenix Ave
Suite 201
Waterbury, CT 06702-1418

Mailing address

80 Phoenix Ave
Suite 201
Waterbury, CT 06702-1418
Phone (203) 756-8021

Other identifiers 1

IdentifierTypeStateIssuer
001451757MedicaidCT

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
I20070612000531 CT Practitioner - Internal MedicinePractitioner - Pediatric Medicine 7810991700 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Prohealth Physicians PCGroup PAC ID 1355246950, 214 clinicians

Practice addresses (Care Compare)

100 Reserve Rd
Suite A4
Danbury, CT 06810-5267
Phone (203) 794-1979

115 Spencer St
Winsted, CT 06098-1140
Phone (860) 738-5814

2 Elizabeth St
Bethel, CT 06801-2100
Phone (203) 791-2221

950 Yale Ave
Wallingford, CT 06492-1858
Phone (203) 265-9600

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Prohealth Physicians PC Internal Medicine CurrentSince May 1, 2017 Accepting new patients
Danbury Medical Group LLC Internal Medicine PastSince Oct 26, 2020 Accepting new patients

Locations

3 Farm Glen Blvd
Farmington, CT 06032
Phone (860) 284-5200

500 Chase Pkwy
Waterbury, CT 06708
Phone (203) 264-7999

115 Spencer St
Winsted, CT 06098
Phone (860) 738-5810

Interoperability endpoints

  • Direct secure messaging: gunjan.sharma.npi1508875089.phpct@direct.optumcare.masshiway.net

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 3

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": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394668800000",
    "number": "1508875089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 PHOENIX AVE",
            "address_2": "SUITE 201",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067021418",
            "telephone_number": "203-756-8021",
            "fax_number": "203-596-9038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 PHOENIX AVE",
            "address_2": "SUITE 201",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067021418",
            "telephone_number": "203-756-8021",
            "fax_number": "203-596-9038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHARMA",
        "first_name": "GUNJAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-05",
        "last_updated": "2014-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "045175",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CT",
            "license": "045175",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001451757",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterbury, CT

Sources for this page

Verify at the official NPI Registry.