NPIMap

Individual provider Active NPI

Srinivasulu Conjeevaram, MD

  • Family Medicine Physician
  • Colchester, CT
National Provider Identifier
1780958058
Registry record updated Mar 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
53644 Issued in CT
Practice address
100 Linwood Ave Ste 2a
Colchester, CT 06415-1138
Phone
(860) 415-3622
Fax
(860) 974-0884
NPI assigned
Mar 2, 2012
Last updated
Mar 24, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 53644 CT
General Practice Physician 208D00000X 4301086842 MI
General Practice Physician 208D00000X 53644 CT
Family Medicine Physician 207Q00000X 53644 CT Primary

Addresses

Primary practice location

100 Linwood Ave Ste 2a
Colchester, CT 06415-1138

Mailing address

11 Winthrop Rd
Apt 2a
West Hartford, CT 06110-1656
Phone (860) 415-3622

Other practice location 1

421 Cottage Grove Rd Ste B
Bloomfield, CT 06002-3170
Phone (860) 242-0034

Other practice location 2

146 Main Street
Somers, CT 06071-1825
Phone (860) 415-3622

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
I20150709000399 CT Practitioner - Family Practice 6103054655 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

100 Linwood Ave
FL 1
Colchester, CT 06415-1138
Phone (860) 531-9484

37 Main St
Hebron, CT 06248-1516

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue412
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Aakaish Sanjeevi Home Health Physicians Family Medicine CurrentSince Nov 26, 2021 Accepting new patients
Vohra Post Acute Care Physicians of the East, PA Family Medicine CurrentSince May 18, 2015 Accepting new patients
Colchester Urgent Care Center LLC Family Medicine CurrentSince Nov 26, 2021 Accepting new patients
Medical Care Center of East Hartford LLC Family Medicine CurrentSince Aug 29, 2018 Accepting new patients
Stafford Medical Group LLC Family Medicine CurrentSince Sep 25, 2018 Accepting new patients

Locations

100 Linwood Ave
Fl 1
Colchester, CT 06415
Phone (860) 531-9484

1224 Mill St
Ste 224
East Berlin, CT 06023
Phone (203) 303-4963

677 Silver Ln
East Hartford, CT 06118
Phone (860) 568-7243

3601 SW 160th Ave
Ste 250
Miramar, FL 33027
Phone (305) 866-9951

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BEHADD/Endpoint/BEHADD

Organizations & group practices 7

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 5

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": "1330646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679616000000",
    "number": "1780958058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 WINTHROP RD",
            "address_2": "APT 2A",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061101656",
            "telephone_number": "860-415-3622",
            "fax_number": "860-540-1226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 LINWOOD AVE STE 2A",
            "city": "COLCHESTER",
            "state": "CT",
            "postal_code": "064151138",
            "telephone_number": "860-415-3622",
            "fax_number": "860-974-0884"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "421 Cottage Grove Rd Ste B",
            "address_purpose": "LOCATION",
            "city": "Bloomfield",
            "state": "CT",
            "postal_code": "060023170",
            "country_code": "US",
            "telephone_number": "860-242-0034",
            "fax_number": "860-242-3301",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "146 Main Street",
            "address_purpose": "LOCATION",
            "city": "Somers",
            "state": "CT",
            "postal_code": "060711825",
            "country_code": "US",
            "telephone_number": "860-415-3622",
            "fax_number": "860-540-1226",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CONJEEVARAM",
        "first_name": "SRINIVASULU",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-03-02",
        "last_updated": "2023-03-24",
        "certification_date": "2023-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "53644",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MI",
            "license": "4301086842",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CT",
            "license": "53644",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CT",
            "license": "53644",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colchester, CT

Sources for this page

Verify at the official NPI Registry.