Individual provider Active NPI

Heather M Nisbeth, M.D.

  • Gastroenterology Physician
  • Southbury, CT
National Provider Identifier
1912952243
Registry record updated Jul 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
032576 Issued in CT
Practice address
22 Old Waterbury Rd
Suite 201
Southbury, CT 06488-3848
Phone
(203) 264-6503
Fax
(203) 262-1430
NPI assigned
May 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 032576 CT Primary

Addresses

Primary practice location

22 Old Waterbury Rd
Suite 201
Southbury, CT 06488-3848

Mailing address

22 Old Waterbury Road
Suite 201
Southbury, CT 06488-3848
Phone (203) 264-6503

Other identifiers 1

IdentifierTypeStateIssuer
004394532MedicaidCT

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
I20120117000608 CT Practitioner - Internal Medicine 3072780956 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
State University of New York at Buffalo School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prospect CT Medical Foundation IncGroup PAC ID 7416244496, 287 clinicians

Practice addresses (Care Compare)

18 Haynes St
Uppr Level
Manchester, CT 06040-4111
Phone (860) 649-7557

64 Robbins St
Waterbury, CT 06708-2613
Phone (203) 573-6263

690 Main St S
Southbury, CT 06488-2217
Phone (203) 264-6503

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
032576CTMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prospect CT Medical Foundation, Inc. Gastroenterology CurrentSince Feb 20, 2018 Accepting new patients

Locations

1801 W Olympic Blvd
#2201
Pasadena, CA 91199

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

690 Main St S
Ste 5
Southbury, CT 06488
Phone (203) 267-4060

Interoperability endpoints

  • Direct secure messaging: heathernisbeth@amggw.allscriptsdirect.net

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279584000000",
    "number": "1912952243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 OLD WATERBURY ROAD",
            "address_2": "SUITE 201",
            "city": "SOUTHBURY",
            "state": "CT",
            "postal_code": "064883848",
            "telephone_number": "203-264-6503",
            "fax_number": "203-262-1430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 OLD WATERBURY RD",
            "address_2": "SUITE 201",
            "city": "SOUTHBURY",
            "state": "CT",
            "postal_code": "064883848",
            "telephone_number": "203-264-6503",
            "fax_number": "203-262-1430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NISBETH",
        "first_name": "HEATHER",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-24",
        "last_updated": "2010-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "CT",
            "license": "032576",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004394532",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Southbury, CT

Sources for this page

Verify at the official NPI Registry.