NPIMap

Organization Active NPI

Ansonia Podiatry Associates, LLC

Doing business as Yale Podiatry Group

  • Podiatrist
  • Ansonia, CT
National Provider Identifier
1689841520
Registry record updated Jan 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
License
000678 Issued in CT
Legal business name
ANSONIA PODIATRY ASSOCIATES, LLC
Doing business as
Yale Podiatry Group
Practice address
364 E Main St
Ansonia, CT 06401-1904
Phone
(203) 734-4806
Fax
(203) 734-8265
NPI assigned
May 9, 2008
Last updated
Jan 9, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2014

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

Authorized official

Name
Dr. Michael S Travisano, D.P.M.NPI 1801807953
Title
Owner
Phone
(203) 734-4806

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 000678 CT
Podiatrist 213E00000X 000678 CT Primary

Addresses

Primary practice location

364 E Main St
Ansonia, CT 06401-1904

Mailing address

364 E Main St
Ansonia, CT 06401-1904
Phone (203) 734-4806

Other identifiers 1

IdentifierTypeStateIssuer
004020517MedicaidCT

Other names 1

  • Yale Podiatry Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080821000302 CT Part B Supplier - Clinic/Group Practice 1850466160 Receives reassigned benefits from 2 practitioners
Practice locations: Ansonia, CT; Shelton, CT
O20100930020843 CT DME Supplier - Physician - Podiatry 1850466160 Practice locations: Ansonia, CT

National Provider Directory

National Provider Directory

Locations

4 Corporate Dr
Ste 384
Shelton, CT 06484
Phone (203) 734-4806

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1210291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389225600000",
    "number": "1689841520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "364 E MAIN ST",
            "city": "ANSONIA",
            "state": "CT",
            "postal_code": "064011904",
            "telephone_number": "203-734-4806",
            "fax_number": "203-734-8265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "364 E MAIN ST",
            "city": "ANSONIA",
            "state": "CT",
            "postal_code": "064011904",
            "telephone_number": "203-734-4806",
            "fax_number": "203-734-8265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANSONIA PODIATRY ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-09",
        "last_updated": "2014-01-09",
        "status": "A",
        "authorized_official_last_name": "TRAVISANO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-734-4806",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CT",
            "license": "000678",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "CT",
            "license": "000678",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004020517",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Yale Podiatry Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ansonia, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.