Roman Spivak, MD

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

License

52868 Issued in CT

Practice address

135 Division St Ste 2
Ansonia, CT 06401-2135

Phone

(203) 308-2705

Fax

(203) 734-0137

NPI assigned

Jun 21, 2007

Last updated

Oct 12, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

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

Specialty

Pulmonary DiseaseAlso: Critical Care (Intensivists)

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Griffin Faculty Physicians IncGroup PAC ID 7618871997, 125 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Griffin Hospital Hospital, Derby, CT, CCN 070031
• St Vincent's Medical Center Hospital, Bridgeport, CT, CCN 070028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: roman.spivak.1@1323.direct.athenahealth.com

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.

• Griffin Faculty Physicians, Inc.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Derby, CT
  • NPI 1598755605
  Medicare reassignment Care Compare group NPD
• The Griffin Hospital

  • General Acute Care Hospital
  • Derby, CT
  • NPI 1184639973
  NPD (past)

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

• SVMC Holdings, Inc

  • General Acute Care Hospital
  • Bridgeport, CT
  • NPI 1942224696
  Care Compare affiliation
• The Griffin Hospital

  • General Acute Care Hospital
  • Derby, CT
  • NPI 1184639973
  Care Compare affiliation

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

{
    "created_epoch": "1182384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539302400000",
    "number": "1780889493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 MAPLE AVE",
            "city": "DERBY",
            "state": "CT",
            "postal_code": "064181328",
            "telephone_number": "203-732-1330",
            "fax_number": "203-732-1332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 DIVISION ST STE 2",
            "city": "ANSONIA",
            "state": "CT",
            "postal_code": "064012135",
            "telephone_number": "203-308-2705",
            "fax_number": "203-734-0137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPIVAK",
        "first_name": "ROMAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-21",
        "last_updated": "2018-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "NY",
            "license": "259527",
            "primary": false
        },
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "CT",
            "license": "52868",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NY",
            "license": "259527",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "CT",
            "license": "52868",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Liqun Song, M.D.
• Milton A Soriano, MSW
• Michelle Marie Sousa-Paco, MA
• Southern Connecticut Dental Group PC
• Spectrum Healthcare Waterbridge, LLC (Hilltop Health Center)
• Matthew Paul Staniewicz, LMSW
• Mary Ellie Stankus, APRN, RN
• Ira J Stein, DDS
• Stephen Moses, M.D., LLC
• Jennifer L Stevens, LPC

• Pulmonary Disease Physician in Ansonia, CT
• Providers in Ansonia, CT by specialty
• Pulmonary Disease Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2018; 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.
• Medicare Care Compare (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.