Imran Ahmed Mridha, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5039 Issued in CT

Practice address

75 Kings Highway Cutoff Ste 3a
Fairfield, CT 06824-5340

Phone

(203) 743-7264

Fax

(203) 792-3920

NPI assigned

Jul 24, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pain and Spine Specialists of Connecticut LLCGroup PAC ID 0143323063, 5 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Pain & Spine Specialists of Connecticut, LLC

  • Interventional Pain Medicine Physician
  • Danbury, CT
  • NPI 1467588020
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1595548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646611200000",
    "number": "1558970558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11350 MCCORMICK RD",
            "address_2": "EXECUTIVE PLAZA 1, STE. 501",
            "city": "HUNT VALLEY",
            "state": "MD",
            "postal_code": "210317958",
            "telephone_number": "703-914-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 KINGS HIGHWAY CUTOFF STE 3A",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068245340",
            "telephone_number": "203-743-7264",
            "fax_number": "203-792-3920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MRIDHA",
        "first_name": "IMRAN",
        "middle_name": "AHMED",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-24",
        "last_updated": "2022-03-07",
        "certification_date": "2022-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "5039",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "imridha@nspc.emadirect.md",
            "affiliation": "N",
            "address_1": "75 Kings Highway Cutoff Ste 3A",
            "city": "Fairfield",
            "state": "CT",
            "country_code": "US",
            "postal_code": "068245340",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Murray A Morrison, MD
• Todd Alexander Morrison, M.D.
• Jessica Mortenson
• Robert M. Moskowitz, M.D.
• Renee Ann Moye, APRN
• MRK Counseling & Wellness, LLC
• Lawrence Daniel Muldoon, M.D.
• Naga Arita Mulpuri
• Claudine Theresa Mundell
• Julia Shook Munoz, RD

• Physician Assistant in Fairfield, CT
• Providers in Fairfield, CT by specialty
• Physician Assistant in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.