NPIMap

Organization Active NPI

East Hartford Pediatric, LLC.

  • Community Health Worker
  • East Hartford, CT
National Provider Identifier
1700898764
Registry record updated Dec 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health WorkerTaxonomy code 172V00000X
License
034733 Issued in CT
Legal business name
EAST HARTFORD PEDIATRIC, LLC.
Practice address
893 Main St
Suite 303
East Hartford, CT 06108-2292
Phone
(860) 289-3047
Fax
(860) 528-4735
NPI assigned
Aug 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2014

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

Authorized official

Name
Dr. Jayashree Venkatesh, M.D.NPI 1447487723
Title
Physician
Phone
(860) 289-3047

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
Community Health WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 172V00000X 034733 CT Primary
Pediatric Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LP0200X 002155 CT

Addresses

Primary practice location

893 Main St
Suite 303
East Hartford, CT 06108-2292

Mailing address

21 Paul Spring Rd
Farmington, CT 06032
Phone (860) 676-1135

Other identifiers 2

IdentifierTypeStateIssuer
008035516MedicaidCT
001347336MedicaidCT

National Provider Directory

National Provider Directory

Locations

893 Main St
Ste 303
East Hartford, CT 06108
Phone (860) 289-3047

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417478400000",
    "number": "1700898764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 PAUL SPRING RD",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "06032",
            "telephone_number": "860-676-1135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "893 MAIN ST",
            "address_2": "SUITE 303",
            "city": "EAST HARTFORD",
            "state": "CT",
            "postal_code": "061082292",
            "telephone_number": "860-289-3047",
            "fax_number": "860-528-4735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST HARTFORD PEDIATRIC, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-11",
        "last_updated": "2014-12-02",
        "status": "A",
        "authorized_official_last_name": "VENKATESH",
        "authorized_official_first_name": "JAYASHREE",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "860-289-3047",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Community Health Worker",
            "state": "CT",
            "license": "034733",
            "primary": true
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CT",
            "license": "002155",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008035516",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001347336",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Hartford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.