Kaitlin C Quallen, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

71903 Issued in CT

Practice address

1110 Durham Rd
Madison, CT 06443-1858

Phone

(203) 421-3600

NPI assigned

May 15, 2019

Last updated

Jan 11, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Prohealth Physicians PC

  • Family Medicine Physician
  • Farmington, CT
  • NPI 1720194053

  Pediatrics

  Medicare reassignment NPD
• Yale University

  dba Yale Medicine

  • Anesthesiology Physician
  • New Haven, CT
  • NPI 1205822236

  Pediatrics

  Medicare reassignment NPD
• Yale University

  • Durable Medical Equipment & Medical Supplies
  • Fairfield, CT
  • NPI 1548066962
  NPD
• PM Pediatrics of Connecticut

  • Urgent Care Clinic/Center
  • West Hartford, CT
  • NPI 1386158467

  Pediatrics

  NPD (past)
• Shoreline Pediatrics & Adolescent Medicine, P.C.

  • Pediatric Adolescent Medicine Physician
  • Madison, CT
  • NPI 1538126941
  NPD (past)

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

{
    "created_epoch": "1557878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704931200000",
    "number": "1841856879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 PLEASANT VALLEY RD STE C",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060428759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 DURHAM RD",
            "city": "MADISON",
            "state": "CT",
            "postal_code": "064431858",
            "telephone_number": "203-421-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUALLEN",
        "first_name": "KAITLIN",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-15",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CT",
            "license": "71903",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Premier Home Health Care Services, Inc (Premier Home Health Care of Connecticut)
• Priority Health Services LLC
• Lauren Elaine Provini, MD
• Henry Puciato, RN, APRN
• Erin Puzycki, LCSW
• Rita Rabheru, MD
• Nicholas Geoffrey Rapport
• Rounak Babula Rawal, M.D.
• Nicholas Alexander Read, DO
• Rebecca L. Petersen, LCSW, LLC

• Pediatrics Physician in Madison, CT
• Providers in Madison, CT by specialty
• Pediatrics Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.