Katherine Riddle

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

63724 Issued in CT

Practice address

2600 Tamarack Ave Ste 200
South Windsor, CT 06074-5560

Phone

(860) 646-1157

NPI assigned

Mar 28, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Obstetrics/Gynecology

Education

Creighton University School of Medicine, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

OBGYN Group of Eastern Connecticut PCGroup PAC ID 2769370352, 12 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Manchester Memorial Hospital Hospital, Manchester, CT, CCN 070027
• Rockville General Hospital Hospital, Vernon, CT, CCN 070012

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: katherine.riddle.1@27673.direct.athenahealth.com

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.

• OBGYN Group of Eastern Connecticut, P.C.

  • Obstetrics & Gynecology Physician
  • South Windsor, CT
  • NPI 1376756908
  Medicare reassignment Care Compare group NPD

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

• Manchester Memorial Hospital, Inc.

  • General Acute Care Hospital
  • Manchester, CT
  • NPI 1881564664
  Care Compare affiliation

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

{
    "created_epoch": "1427500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579651200000",
    "number": "1669866588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 TAMARACK AVE STE 200",
            "city": "SOUTH WINDSOR",
            "state": "CT",
            "postal_code": "060745560",
            "telephone_number": "203-641-0800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 TAMARACK AVE STE 200",
            "city": "SOUTH WINDSOR",
            "state": "CT",
            "postal_code": "060745560",
            "telephone_number": "860-646-1157"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5301 McAuley Dr",
            "address_purpose": "LOCATION",
            "city": "Ypsilanti",
            "state": "MI",
            "postal_code": "481971051",
            "country_code": "US",
            "telephone_number": "734-712-3456",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RIDDLE",
        "first_name": "KATHERINE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-03-28",
        "last_updated": "2020-01-22",
        "certification_date": "2020-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CT",
            "license": "63724",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Revive Therapeutics, LLC
• Rheumatology Specialists of Connecticut, Inc.
• Rheumatology Specialists of Connecticut, Inc.
• Rheumatology Specialists of Connecticut, Inc.
• Rheumatology Specialists of Connecticut, Inc.
• Right Track Psychotherapy LLC
• Nancy Elaine Rizza, PA-C
• Robert C. Goodwin MD LLC
• Robert Fogel LLC
• Robert N. Burstein, DDS

• Obstetrics & Gynecology Physician in South Windsor, CT
• Providers in South Windsor, CT by specialty
• Obstetrics & Gynecology Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2020; 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.