Etny Raul Candelario, MD
Individual provider Active NPI Family Medicine Physician · Mystic, CT
NPI 1568084150 · NPPES record last updated Aug 23, 2024
Key facts
- NPI
- 1568084150
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 79070 (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
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Hospital & facility affiliations 8
Medicare Care Compare profile
- 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 Inc
Practice addresses (Care Compare)
100 Perkins Farm Dr
Suite 203
Mystic, CT 06355-4041
Phone (860) 572-8911
Hospital & facility affiliations
- Hartford Healthcare at Home
- Yale New Haven Health - Health at Home Southeast
- William W Backus Hospital
- Lawrence & Memorial Hospital
- Westerly Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
| Removal or shaving of skin growth | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240904001976 | CT | Practitioner - Family Practice | 4981086162 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301510053 | MI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hartford Healthcare Medical Group, Inc | Family Medicine | Current |
Accepting new patients |
| Hartford Healthcare Medical Group, Inc | Past |
Accepting new patients | |
| Hartford Healthcare Medical Group Specialists, PLLC | Past | Accepting new patients |
Locations
100 Perkins Farm Dr
Ste 203
Mystic, CT 06355
Phone (201) 787-1446
55 Meriden Ave
Ste 1D
Southington, CT 06489
Phone (860) 276-5144
1290 Silas Deane Hwy
Ste 203
Wethersfield, CT 06109
Interoperability endpoints
- etny.candelario@conviva.eclinicaldirectplus.com
- ecandelario31585@direct.utmsa.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4301510053 | MI | |
| Family Medicine Physician | 207Q00000X | U6458 | TX | |
| Family Medicine Physician | 207Q00000X | 79070 | CT | Yes |
Addresses
Primary practice location
100 Perkins Farm Dr Ste 203
Mystic, CT 06355-4041
Mailing address
1339 Fair Ave
San Antonio, TX 78223-1437
Phone (210) 923-4372
Other practice location 1
1339 Fair Ave
San Antonio, TX 78223-1437
Phone (210) 923-4372
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | etny.candelario@conviva.eclinicaldirectplus.com | Direct |
Other providers in Mystic, CT
- Kim Michelle Bucko
- Leah Bueneman
- Danielle Mae Buffington
- Stephanie Buske
- Tess Marie Cagenello
- Edmond Francis Cardinal Jr.
- Cdmi LLC
- Jason T Cerro
- Wade Lindsay Chartier
- Curt Ira Cheslog
All providers in Mystic, CT · Family Medicine Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 23, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.