NPIMap

Organization Active NPI

Charter Anesthesiology LLC

  • Anesthesiology Physician
  • West Hartford, CT
National Provider Identifier
1730674532
Registry record updated Aug 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
CHARTER ANESTHESIOLOGY LLC
Practice address
1093 Prospect Ave
West Hartford, CT 06105-1104
Phone
(203) 980-0368
NPI assigned
Jun 25, 2018
Last updated
Aug 27, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2020

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

Authorized official

Name
Keith Gipson, MDNPI 1124279831
Title
Member
Phone
(203) 980-0368

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X Primary

Addresses

Primary practice location

1093 Prospect Ave
West Hartford, CT 06105-1104

Mailing address

151 N Main St
Bristol, CT 06010-9992
Phone (203) 980-0368

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190405000747 MA Part B Supplier - Clinic/Group Practice 2163763830 Receives reassigned benefits from 12 practitioners
Practice locations: Springfield, MA
O20190520001013 CT Part B Supplier - Clinic/Group Practice 2163763830 Receives reassigned benefits from 84 practitioners
Practice locations: Winsted, CT; West Hartford, CT; Bristol, CT; Torrington, CT; Southport, CT; Southington, CT; Southbury, CT; Manchester, CT…

National Provider Directory

National Provider Directory

Locations

100 Simsbury Rd
Ste 206
Avon, CT 06001
Phone (860) 676-4820

499 Farmington Ave
Ste 220
Farmington, CT 06032
Phone (860) 676-8111

60 Washington Ave
Hamden, CT 06518
Phone (203) 248-4362

388 W Center St
Bldg A
Manchester, CT 06040
Phone (860) 649-1120

60 Wellington Rd
Milford, CT 06461
Phone (203) 878-2010

5000 Main St
Trumbull, CT 06611
Phone (203) 374-0404

863 N Main Street Ext
Ste 301
Wallingford, CT 06492
Phone (203) 269-0885

345 N Main St
Ste 201
West Htfd, CT 06117
Phone (860) 561-7222

Practitioners & affiliated clinicians

Practitioners 97

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.

View all 97

NPI Registry JSON

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

{
    "created_epoch": "1529884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598486400000",
    "number": "1730674532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 N MAIN ST",
            "city": "BRISTOL",
            "state": "CT",
            "postal_code": "060109992",
            "telephone_number": "203-980-0368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1093 PROSPECT AVE",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061051104",
            "telephone_number": "203-980-0368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARTER ANESTHESIOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-25",
        "last_updated": "2020-08-27",
        "certification_date": "2020-08-27",
        "status": "A",
        "authorized_official_last_name": "GIPSON",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "203-980-0368",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Hartford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2020; 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.