Tanya Chiarelli Ave'Lallemant, MD
Individual provider Active NPI Dermatology Physician · Bristol, CT
NPI 1861497620 · NPPES record last updated Jun 19, 2010
Key facts
- NPI
- 1861497620
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dermatology Physician 207N00000X
- License
- 040734 (CT)
- Practice address
- 72 Pine St
Unit 3
Bristol, CT 06010-6960 - Phone
- (860) 585-1729
- Fax
- (860) 589-9030
- NPI assigned
- Jun 17, 2005
- Sex
- Female
- Sole proprietor
- Yes
Medicare Care Compare profile
- Specialty
- Dermatology
- Education
- University of Connecticut School of Medicine, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
72 Pine St
Bristol, CT 06010-6960
Phone (860) 585-1729
Merit-based Incentive Payment System (MIPS)
- Final score
- 0 of 100
- Quality
- 0
- Improvement activities
- 0
- Cost
- 0
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1415 |
| Skin biopsy | 238 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100127000015 | CT | Practitioner - Dermatology | 9234271412 | Practice locations: Bristol, CT |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 040734 | CT | Yes |
Addresses
Primary practice location
72 Pine St
Unit 3
Bristol, CT 06010-6960
Mailing address
72 Pine St
Unit 3
Bristol, CT 06010-6960
Phone (860) 585-1729
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407346 | Medicaid | CT |
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All providers in Bristol, CT · Dermatology Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 19, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.