Organization Active NPI

Ali Banki, D.O., P.C.

  • Dermatology Physician
  • Glastonbury, CT
National Provider Identifier
1811293350
Registry record updated Feb 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
048744 Issued in CT
Legal business name
ALI BANKI, D.O., P.C.
Practice address
15 Concord St
Glastonbury, CT 06033-2135
Phone
(860) 659-2779
Fax
(860) 633-9315
NPI assigned
Feb 1, 2011
Last updated
Feb 1, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2011

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

Authorized official

Name
Ali Banki, D.O.NPI 1912218918
Title
Owner/President
Phone
(860) 659-2779

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
Dermatology Physician 207N00000X 048744 CT Primary

Addresses

Primary practice location

15 Concord St
Glastonbury, CT 06033-2135

Mailing address

15 Concord St
Glastonbury, CT 06033-2135
Phone (860) 659-2779

Other identifiers 4

IdentifierTypeStateIssuer
P4181742OtherCTOXFORD
6426153OtherCTAETNA
048744OtherCTCONNECTICARE, INC.
040048744CT01OtherCTANTHEM BLUE CROSS/BLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110329000075 CT Part B Supplier - Clinic/Group Practice 8123201159 Receives reassigned benefits from 3 practitioners
Practice locations: Glastonbury, CT

National Provider Directory

National Provider Directory

Locations

1484 Highland Ave
Cheshire, CT 06410

1484 Highland Ave
Ste 8
Cheshire, CT 06410

2928 Main St
Ste 200
Glastonbury, CT 06033
Phone (860) 430-2344

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1296518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296518400000",
    "number": "1811293350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 CONCORD ST",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060332135",
            "telephone_number": "860-659-2779",
            "fax_number": "860-633-9315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 CONCORD ST",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060332135",
            "telephone_number": "860-659-2779",
            "fax_number": "860-633-9315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALI BANKI, D.O., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-01",
        "last_updated": "2011-02-01",
        "status": "A",
        "authorized_official_last_name": "BANKI",
        "authorized_official_first_name": "ALI",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "860-659-2779",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CT",
            "license": "048744",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P4181742",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "6426153",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONNECTICARE, INC.",
            "identifier": "048744",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS/BLUE SHIELD",
            "identifier": "040048744CT01",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glastonbury, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2011; 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.