Active NPI
Shijia Li
- Student in an Organized Health Care Education/Training Program
- Bridgeport, CT
National Provider Identifier
1710735055
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 267 Grant Street, Med Ed Podium 4
Bridgeport, CT 06610-0120 - Phone
- (203) 384-4442
- NPI assigned
- May 10, 2024
- Last updated
- Aug 1, 2024
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | NU | Primary |
Addresses
Primary practice location
267 Grant Street, Med Ed Podium 4
Bridgeport, CT 06610-0120
Mailing address
267 Grant Street, Med Ed Podium 4
Bridgeport, CT 06610-0120
Phone (203) 384-4442
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240813001808 | CT | Order and Referring Only - Internal Medicine | 9234677931 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1715299200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722470400000",
"number": "1710735055",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "267 GRANT STREET, MED ED PODIUM 4",
"city": "BRIDGEPORT",
"state": "CT",
"postal_code": "066100120",
"telephone_number": "203-384-4442"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "267 GRANT STREET, MED ED PODIUM 4",
"city": "BRIDGEPORT",
"state": "CT",
"postal_code": "066100120",
"telephone_number": "203-384-4442"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LI",
"first_name": "SHIJIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-05-10",
"last_updated": "2024-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bridgeport, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2024; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.