NPIMap

Organization Active NPI

Connecticut Vascular Surgical Associates, PC

  • Vascular Surgery Physician
  • Shelton, CT
National Provider Identifier
1801805403
Registry record updated Oct 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
Legal business name
CONNECTICUT VASCULAR SURGICAL ASSOCIATES, PC
Practice address
100 Beard Sawmill Rd Ste 250
Shelton, CT 06484-6150
Phone
(203) 922-7870
Fax
(203) 922-7872
NPI assigned
Aug 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2019

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

Authorized official

Name
Seth Barak Blattman, M.D.NPI 1477508778
Title
President
Phone
(203) 922-7870

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
Vascular Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0129X Primary

Addresses

Primary practice location

100 Beard Sawmill Rd Ste 250
Shelton, CT 06484-6150

Mailing address

501 Kings Hwy E
Suite 112
Fairfield, CT 06825-4867
Phone (203) 382-1900

Other practice location 1

501 Kings Hwy E
Suite 112
Fairfield, CT 06825-4867
Phone (203) 382-1900

Other identifiers 1

IdentifierTypeStateIssuer
004198489MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060819000003 CT Part B Supplier - Clinic/Group Practice 9931102654 Receives reassigned benefits from 9 practitioners
Practice locations: Shelton, CT

National Provider Directory

National Provider Directory

Locations

501 Kings Hwy E
Ste 112
Fairfield, CT 06825
Phone (203) 382-1900

100 Beard Sawmill Rd
Ste 250
Shelton, CT 06484
Phone (203) 227-1324

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571270400000",
    "number": "1801805403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 KINGS HWY E",
            "address_2": "SUITE 112",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068254867",
            "telephone_number": "203-382-1900",
            "fax_number": "203-382-0019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 BEARD SAWMILL RD STE 250",
            "city": "SHELTON",
            "state": "CT",
            "postal_code": "064846150",
            "telephone_number": "203-922-7870",
            "fax_number": "203-922-7872"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "501 Kings Hwy E",
            "address_2": "Suite 112",
            "address_purpose": "LOCATION",
            "city": "Fairfield",
            "state": "CT",
            "postal_code": "068254867",
            "country_code": "US",
            "telephone_number": "203-382-1900",
            "fax_number": "203-382-0019",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CONNECTICUT VASCULAR SURGICAL ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-05",
        "last_updated": "2019-10-17",
        "status": "A",
        "authorized_official_last_name": "BLATTMAN",
        "authorized_official_first_name": "SETH",
        "authorized_official_middle_name": "BARAK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "203-922-7870",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004198489",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelton, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2019; 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.