Primary Care of Shelton LLC

Key facts

NPI: 1700927720
Entity type: Organization (NPI type 2)
Primary specialty: Internal Medicine Physician 207R00000X
License: 038488 (CT)
Legal business name: PRIMARY CARE OF SHELTON LLC
Practice address: 555 Bridgeport Ave
Shelton, CT 06484-4749
Phone: (203) 225-0506
NPI assigned: Feb 11, 2007
Organization subpart: No

Authorized official

Name: Bardia Asgari, MD NPI 1811938533
Title: Ceo
Phone: (203) 225-0506

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

Practitioners 2

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

Bardia Asgari, MD Internal Medicine Physician · Shelton, CT · NPI 1811938533

Medicare reassignment Care Compare group NPD Authorized official CT · INTERNAL MEDICINE
Rianne Boothe, NP Adult Health Nurse Practitioner · Shelton, CT · NPI 1588437917

Medicare reassignment Care Compare group NPD CT

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA number	Laboratory	Certificate	Expires
07D1074348	Primary Care of Shelton LLC 555 Bridgeport Avenue, Shelton, CT 06484	Certificate of waiver	Sep 25, 2027

Medicare participation

Medicare fee-for-service enrollment: Enrolled in CT

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20070326000059	CT	Part B Supplier - Clinic/Group Practice	0840394292	Receives reassigned benefits from 2 practitioners Practice locations: Shelton, CT

National Provider Directory

Interoperability endpoints

FHIR API: https://api.platform.athenahealth.com/17254/brand/1/csg/1/fhir/r4

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Internal Medicine Physician Group: 193400000X SINGLE SPECIALTY GROUP	207R00000X	038488	CT	Yes

Addresses

Primary practice location

555 Bridgeport Ave
Shelton, CT 06484-4749

Mailing address

555 Bridgeport Ave
Shelton, CT 06484-4749
Phone (203) 225-0506

Other providers in Shelton, CT

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Potenza Wellness Services LLC
Stephanie Potenza, LMFT
Power Chiropractic LLC
Beatriz Helena Preter, LCSW
Princeton Longevity Medical Group of Connecticut LLC
Hunter Prindle-Nelson, ATC
Philip M Prior, MSPT
Progressive Institute LLC
Brittany Provenzano, RN, NP

All providers in Shelton, CT · Internal 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 Sep 15, 2008. 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.
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.

Verify at the official NPI Registry.