Suhradam Medical Practice, LLC

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

049253 Issued in CT

Legal business name

SUHRADAM MEDICAL PRACTICE, LLC

Practice address

50 Toll Gate Rd
Berlin, CT 06037-3606

Phone

(860) 438-6004

Fax

(860) 740-7103

NPI assigned

Mar 15, 2016

Organization subpart

No

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

Authorized official

Name

Brimal Babubhai PatelNPI 1083879522

Title

Ceo

Phone

(860) 438-6004

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Practitioners 3

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

• Brimal B Patel, MD

  • Family Medicine Physician
  • Naugatuck, CT
  • NPI 1083879522
  Medicare reassignment NPD Authorized official
• Edmond Beqiri, MPA

  • Physician Assistant
  • Hartford, CT
  • NPI 1346503612
  Medicare reassignment
• Dennis Laverne Huebner, M.D.

  • Internal Medicine Physician
  • Naugatuck, CT
  • NPI 1043372568
  NPD (past)

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

{
    "created_epoch": "1458000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458000000000",
    "number": "1932560281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 TOLL GATE RD",
            "city": "BERLIN",
            "state": "CT",
            "postal_code": "060373606",
            "telephone_number": "860-438-6004",
            "fax_number": "860-740-7103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 TOLL GATE RD",
            "city": "BERLIN",
            "state": "CT",
            "postal_code": "060373606",
            "telephone_number": "860-438-6004",
            "fax_number": "860-740-7103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUHRADAM MEDICAL PRACTICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-15",
        "last_updated": "2016-03-15",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "BRIMAL",
        "authorized_official_middle_name": "BABUBHAI",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "860-438-6004"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "CT",
            "license": "049253",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1083879522",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Starling Physicians, PLLC
• Stop and Shop Supermarket Co LLC
• Nurjhan Strachan-Spence, LMFT
• Teo-Carlo Straun, M.D.
• Suhradam Medical
• Sullivan Counseling and Wellness, LLC
• Catherine S. Sullivan, LCSW
• Lynn Swanson, APRN
• Janet K Szymanski, RPH
• Kyrsti Ann Tam, LMFT

• Multi-Specialty Clinic/Center in Berlin, CT
• Providers in Berlin, CT by specialty
• Multi-Specialty Clinic/Center in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2016; 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.