NPIMap

Individual provider Active NPI

Ketan Ramanlal Bulsara, MD

  • Neurological Surgery Physician
  • Farmington, CT
National Provider Identifier
1780888529
Registry record updated Sep 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
045293 Issued in CT
Practice address
263 Farmington Ave
Farmington, CT 06030-0001
Phone
(860) 679-8080
NPI assigned
Jun 14, 2007
Last updated
Sep 29, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 045293 CT
Neurological Surgery Physician 207T00000X 045293 CT Primary

Addresses

Primary practice location

263 Farmington Ave
Farmington, CT 06030-0001

Mailing address

Uconn Medical Group 263 Farmington Avenue
Farmington, CT 06030-8063
Phone (860) 679-8080

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kbulsara9292@direct.med.uchc.edu

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070919000678 CT Practitioner - NeurosurgeryPractitioner - Interventional Radiology 5799746970 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
NeurosurgeryAlso: Interventional Radiology
Education
Duke University School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

263 Farmington Ave
Farmington, CT 06030-0001
Phone (860) 679-3692

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
045293CTMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Connecticut Health Center CurrentSince May 12, 2017 Accepting new patients
State of Connecticut CurrentSince Apr 1, 2020 Accepting new patients
State of Connecticut CurrentSince Apr 1, 2020 Accepting new patients
University of Connecticut Health Center CurrentSince May 12, 2017 Accepting new patients
University of Connecticut Health Center Past Accepting new patients

Locations

117 Albany Tpke
Canton, CT 06019
Phone (860) 658-3444

263 Farmington Ave
Farmington, CT 06030
Phone (860) 679-4477

5 Munson Rd
Farmington, CT 06032
Phone (860) 679-4888

65 Kane St
West Hartfrd, CT 06119
Phone (860) 523-6421

Interoperability endpoints

  • Direct secure messaging: kbulsara37605@connecticutchildrens.direct-ci.com
  • Direct secure messaging: kbulsara9292@direct.med.uchc.edu

Organizations & group practices 5

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

Hospital & facility affiliations 3

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": "1181779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664409600000",
    "number": "1780888529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "UCONN MEDICAL GROUP 263 FARMINGTON AVENUE",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060308063",
            "telephone_number": "860-679-8080",
            "fax_number": "860-679-1430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "263 FARMINGTON AVE",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060300001",
            "telephone_number": "860-679-8080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULSARA",
        "first_name": "KETAN",
        "middle_name": "RAMANLAL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-14",
        "last_updated": "2022-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CT",
            "license": "045293",
            "primary": false
        },
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "CT",
            "license": "045293",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kbulsara9292@direct.med.uchc.edu",
            "affiliation": "N",
            "address_1": "Uconn Medical Group",
            "address_2": "263 Farmington Avenue",
            "city": "Farmington",
            "state": "CT",
            "country_code": "US",
            "postal_code": "060300001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Farmington, CT

Sources for this page

Verify at the official NPI Registry.