Etny Raul Candelario, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

79070 Issued in CT

Practice address

100 Perkins Farm Dr Ste 203
Mystic, CT 06355-4041

Phone

(860) 576-8911

Fax

(860) 572-7758

NPI assigned

May 18, 2020

Last updated

Aug 23, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 2019

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)

Hospital & facility affiliations

• Hartford Healthcare at Home Home health agency, East Hartford, CT, CCN 077041
• Yale New Haven Health - Health at Home Southeast Home health agency, Waterford, CT, CCN 077015
• William W Backus Hospital Hospital, Norwich, CT, CCN 070024
• Lawrence & Memorial Hospital Hospital, New London, CT, CCN 070007
• Westerly Hospital Hospital, Westerly, RI, CCN 410013

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ecandelario31585@direct.utmsa.com
• Direct secure messaging: etny.candelario@conviva.eclinicaldirectplus.com

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.

• Hartford Healthcare Medical Group, Inc

  dba Hartford HealthCare Medical Group

  • Surgery Physician
  • Wethersfield, CT
  • NPI 1043561301

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Hartford Healthcare Medical Group Specialists, PLLC

  • Surgery Physician
  • Hartford, CT
  • NPI 1023584216
  NPD (past)
• Hartford Healthcare Medical Group, Inc

  • Durable Medical Equipment & Medical Supplies
  • Farmington, CT
  • NPI 1720140221
  NPD (past)

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

• Hartford Healthcare at Home, Inc

  • Home Health Agency
  • Wethersfield, CT
  • NPI 1073529566
  Care Compare affiliation
• Lawrence and Memorial Hospital, Inc.

  dba Lawrence and Memorial Hospital

  • General Acute Care Hospital
  • New London, CT
  • NPI 1073530879
  Care Compare affiliation
• Lawrence and Memorial Hospital, Inc.

  dba Lawrence and Memorial Hospital

  • General Acute Care Hospital
  • New London, CT
  • NPI 1700092459
  Care Compare affiliation
• The William W Backus Hospital

  • General Acute Care Hospital
  • Norwich, CT
  • NPI 1467517235
  Care Compare affiliation
• The William W Backus Hospital

  • General Acute Care Hospital
  • Norwich, CT
  • NPI 1639135718
  Care Compare affiliation
• Visiting Nurse Association of Southeastern Connecticut

  • Home Health Agency
  • Waterford, CT
  • NPI 1265490940
  Care Compare affiliation
• William W Backus Hospital

  • Psychiatric Hospital Unit
  • Norwich, CT
  • NPI 1730243536
  Care Compare affiliation
• LMW Healthcare Inc.

  dba Westerly Hospital

  • General Acute Care Hospital
  • Westerly, RI
  • NPI 1447595368
  Care Compare affiliation

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

{
    "created_epoch": "1589760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724371200000",
    "number": "1568084150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1339 FAIR AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782231437",
            "telephone_number": "210-923-4372",
            "fax_number": "210-923-5581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 PERKINS FARM DR STE 203",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "063554041",
            "telephone_number": "860-576-8911",
            "fax_number": "860-572-7758"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1339 Fair Ave",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782231437",
            "country_code": "US",
            "telephone_number": "210-923-4372",
            "fax_number": "210-923-5581",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CANDELARIO",
        "first_name": "ETNY",
        "middle_name": "RAUL",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-05-18",
        "last_updated": "2024-08-23",
        "certification_date": "2024-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301510053",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "U6458",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CT",
            "license": "79070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "etny.candelario@conviva.eclinicaldirectplus.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1567 Goliad Rd",
            "city": "San Antonio",
            "state": "TX",
            "country_code": "US",
            "postal_code": "78223",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Linda M Brustolon, LPTA
• Kim Michelle Bucko, OTR
• Leah Bueneman, PA-C
• Stephanie Buske
• Tess Marie Cagenello
• Edmond Francis Cardinal Jr., MSPT
• Cdmi LLC
• Jason T Cerro, LPC
• Wade Lindsay Chartier, LADC
• Curt Ira Cheslog, PT, MSPT, OCS

• Family Medicine Physician in Mystic, CT
• Providers in Mystic, CT by specialty
• Family Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2024; 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.