NPIMap

Individual provider Active NPI

Ross G Utter, PA

  • Medical Physician Assistant
  • Waterbury, CT
National Provider Identifier
1831156249
Registry record updated Jan 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
001124 Issued in CT
Practice address
134 Grandview Ave
Waterbury, CT 06708-2507
Phone
(203) 756-8911
Fax
(203) 574-0548
NPI assigned
Apr 28, 2006
Last updated
Jan 30, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 001124 CT Primary
Surgical Physician Assistant 363AS0400X 001124 CT

Addresses

Primary practice location

134 Grandview Ave
Waterbury, CT 06708-2507

Mailing address

134 Grandview Ave
Waterbury, CT 06708
Phone (203) 756-8911

Other identifiers 5

IdentifierTypeStateIssuer
51124OtherAIM
711609OtherCTCARE
OR0365OtherAETNA HEALTHNET
290001124CT02OtherANTHEM
A437740OtherOXFORD

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
I20080404000042 CT Practitioner - Physician Assistant 1052400264 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Diagnostic Radiology Associates LLCGroup PAC ID 7113939505, 24 clinicians

Practice addresses (Care Compare)

134 Grandview Ave
Suite 101
Waterbury, CT 06708-2507
Phone 2035969793254

Merit-based Incentive Payment System (MIPS)

Final score
84.52 of 100Reported as group
Quality
56.11
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
001124CTMDProfessional Counselor
1124CTMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Naugatuck Valley Computerized Imaging Past Accepting new patients
Prospect CT Medical Foundation, Inc. Medical Past Accepting new patients
Imaging Partners, LLC PastSince Apr 30, 2003 Accepting new patients
CT Emergency Medicine Specialists, LLC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: rutter@direct.wtbyhosp.org

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1146182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1201651200000",
    "number": "1831156249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 GRANDVIEW AVE",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "06708",
            "telephone_number": "203-756-8911",
            "fax_number": "203-574-0548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 GRANDVIEW AVE",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067082507",
            "telephone_number": "203-756-8911",
            "fax_number": "203-574-0548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UTTER",
        "first_name": "ROSS",
        "middle_name": "G",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-28",
        "last_updated": "2008-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "001124",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CT",
            "license": "001124",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AIM",
            "identifier": "51124",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CTCARE",
            "identifier": "711609",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HEALTHNET",
            "identifier": "OR0365",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "290001124CT02",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "A437740",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterbury, CT

Sources for this page

Verify at the official NPI Registry.