Individual provider Active NPI

Tijana Samardzic, MD

  • Internal Medicine Physician
  • Waterbury, CT
National Provider Identifier
1851910871
Registry record updated Jul 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
73003 Issued in CT
Practice address
160 Robbins St
Waterbury, CT 06708-2652
Phone
(203) 573-7284
NPI assigned
Apr 9, 2020
Last updated
Jul 14, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 390200000X
Internal Medicine Physician 207R00000X 73003 CT Primary

Addresses

Primary practice location

160 Robbins St
Waterbury, CT 06708-2652

Mailing address

64 Robbins St
Waterbury, CT 06708-2600

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20200826002550 CT Practitioner - Internal MedicinePractitioner - Hospitalist 6204253925 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Medical Group, Inc. Internal Medicine CurrentSince Jul 1, 2024 Accepting new patients
Prospect CT Medical Foundation, Inc. Internal Medicine CurrentSince Jul 1, 2023 Accepting new patients
Prospect Waterbury, Inc. CurrentSince Jun 21, 2020 Accepting new patients

Locations

1801 W Olympic Blvd
#2201
Pasadena, CA 91199

18 Haynes St
Uppr
Manchester, CT 06040
Phone (860) 649-7557

95 Armory Rd
Stratford, CT 06614
Phone (203) 384-3388

160 Robbins St
Waterbury, CT 06708
Phone (203) 573-7284

64 Robbins St
Waterbury, CT 06708
Phone (203) 573-7142

Organizations & group practices 3

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": "1586390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689292800000",
    "number": "1851910871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "64 ROBBINS ST",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067082600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 ROBBINS ST",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067082652",
            "telephone_number": "203-573-7284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMARDZIC",
        "first_name": "TIJANA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-09",
        "last_updated": "2023-07-14",
        "certification_date": "2023-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": "390200000X",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "73003",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterbury, CT

Sources for this page

Verify at the official NPI Registry.