Individual provider Active NPI

Mary Braisted, RDN CDN

  • Registered Dietitian
  • Middletown, CT
National Provider Identifier
1831846203
Registry record updated Mar 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Practice address
675 Main St
Middletown, CT 06457-2732
Phone
(860) 347-6971
NPI assigned
Mar 7, 2022
Last updated
Mar 7, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X Primary

Addresses

Primary practice location

675 Main St
Middletown, CT 06457-2732

Mailing address

180 Randolph Rd
Middletown, CT 06457-5605

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240110004610 CT Practitioner - Registered Dietitian Or Nutrition Professional 7517318850 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Registered Dietitian Or Nutrition Professional
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Health Center IncGroup PAC ID 0547169138, 149 clinicians

Practice addresses (Care Compare)

19 Grand St
Middletown, CT 06457-2705

675 Main St
Middletown, CT 06457-2732
Phone (860) 347-6971

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Center Inc CurrentSince Dec 1, 2023 Accepting new patients
Community Health Center Inc Current Accepting new patients

Locations

134 State St
Meriden, CT 06450
Phone (203) 237-2229

19 Grand St
Middletown, CT 06457
Phone (860) 323-0172

Interoperability endpoints

  • Direct secure messaging: mary.braisted@chcict.eclinicaldirectplus.com

Organizations & group practices 2

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": "1646611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646611200000",
    "number": "1831846203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 RANDOLPH RD",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064575605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 MAIN ST",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064572732",
            "telephone_number": "860-347-6971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAISTED",
        "first_name": "MARY",
        "credential": "RDN CDN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-07",
        "last_updated": "2022-03-07",
        "certification_date": "2022-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Middletown, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.