Individual provider Active NPI

Suguru Imaeda, MD

  • Dermatology Physician
  • New Haven, CT
National Provider Identifier
1760472237
Registry record updated Dec 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
032326 Issued in CT
Practice address
55 Lock Street
New Haven, CT 06520-8237
Phone
(203) 432-0076
Fax
(203) 432-7289
NPI assigned
Oct 26, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 032326 CT Primary

Addresses

Primary practice location

55 Lock Street
New Haven, CT 06520-8237

Mailing address

PO Box 208237
55 Lock Street
New Haven, CT 06520-8237
Phone (203) 432-0076

Other identifiers 1

IdentifierTypeStateIssuer
001323261MedicaidCT

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040322001517 CT Practitioner - Dermatology 4587555396 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Albert Einstein College of Medicine of Yeshiva University, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Yale UniversityGroup PAC ID 9436061736, 2,632 clinicians

Practice addresses (Care Compare)

15 York St
New Haven, CT 06510-3221
Phone (203) 688-6445

55 Lock St
New Haven, CT 06511-3603
Phone (203) 432-0076

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.36 of 100Reported as group
Quality
77.36
Promoting interoperability
100
Improvement activities
40
Cost
74.27

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions45
Removal or shaving of skin growth1-10
Skin biopsy11

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
032326CTMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Yale University Dermatology Current Accepting new patients
Yale University CurrentSince Jul 1, 1993 Accepting new patients

Locations

15 York St
New Haven, CT 06510
Phone (203) 688-5303

55 Lock St
New Haven, CT 06511
Phone (203) 432-0076

800 Howard Ave
New Haven, CT 06519
Phone (203) 785-2140

Interoperability endpoints

  • Direct secure messaging: simaeda3463@direct.ynhh.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1130284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1293580800000",
    "number": "1760472237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 208237",
            "address_2": "55 LOCK STREET",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065208237",
            "telephone_number": "203-432-0076",
            "fax_number": "203-432-7289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 LOCK STREET",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065208237",
            "telephone_number": "203-432-0076",
            "fax_number": "203-432-7289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IMAEDA",
        "first_name": "SUGURU",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-26",
        "last_updated": "2010-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CT",
            "license": "032326",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001323261",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New Haven, CT

Sources for this page

Verify at the official NPI Registry.