Active NPI
Gary C Vescera, HIS
- Specialist
- Meriden, CT
National Provider Identifier
1649316647
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 365
- Practice address
- 620 W Main St
Meriden, CT 06451-2767 - Phone
- (203) 634-1338
- NPI assigned
- Jan 29, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 365 | CT | Primary |
Addresses
Primary practice location
620 W Main St
Meriden, CT 06451-2767
Mailing address
9 Summitt Rd
Prospect, CT 06712
Phone (203) 574-5377
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004242632 | Medicaid | CT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1291248000000",
"number": "1649316647",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9 SUMMITT RD",
"city": "PROSPECT",
"state": "CT",
"postal_code": "06712",
"telephone_number": "203-574-5377"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "620 W MAIN ST",
"city": "MERIDEN",
"state": "CT",
"postal_code": "064512767",
"telephone_number": "203-634-1338"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VESCERA",
"first_name": "GARY",
"middle_name": "C",
"name_prefix": "Mr.",
"credential": "HIS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-29",
"last_updated": "2010-12-02",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CT",
"license": "365",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004242632",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Meriden, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.