NPIMap

Organization Active NPI

Waire LLC

  • Psychiatry Physician
  • Ellington, CT
National Provider Identifier
1871744243
Registry record updated Feb 24, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
043112 Issued in CT
Legal business name
WAIRE LLC
Practice address
105 West Rd
Ellington, CT 06029-5700
Phone
(860) 871-5402
Fax
(860) 871-5413
NPI assigned
Oct 3, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2015

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

Authorized official

Name
Dr. Erum Shahab, MDNPI 1669434049
Title
Owner
Phone
(860) 871-5402

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X 043112 CT Primary
Addiction Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0802X 043112 CT
Clinic/Center 261Q00000X 043112 CT

Addresses

Primary practice location

105 West Rd
Ellington, CT 06029-5700

Mailing address

105 West Rd
Ellington, CT 06029-4247
Phone (860) 871-5402

Other names 1

  • ellington behavioral health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081016000105 CT Part B Supplier - Clinic/Group Practice 4183782360 Receives reassigned benefits from 3 practitioners
Practice locations: Ellington, CT

National Provider Directory

National Provider Directory

Locations

4 West Rd
#4
Ellington, CT 06029
Phone (860) 871-5402

105 West Rd
Ste 6
Ellington, CT 06029
Phone (860) 422-4400

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1222992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424736000000",
    "number": "1871744243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 WEST RD",
            "city": "ELLINGTON",
            "state": "CT",
            "postal_code": "060294247",
            "telephone_number": "860-871-5402",
            "fax_number": "860-871-5413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 WEST RD",
            "city": "ELLINGTON",
            "state": "CT",
            "postal_code": "060295700",
            "telephone_number": "860-871-5402",
            "fax_number": "860-871-5413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAIRE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-03",
        "last_updated": "2015-02-24",
        "status": "A",
        "authorized_official_last_name": "SHAHAB",
        "authorized_official_first_name": "ERUM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-871-5402",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CT",
            "license": "043112",
            "primary": true
        },
        {
            "code": "2084P0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": "CT",
            "license": "043112",
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CT",
            "license": "043112",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ellington behavioral health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ellington, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.