Active NPI
Andrea Radebold, MD
- Internal Medicine Physician
- Branford, CT
National Provider Identifier
1942264288
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 042296
- Practice address
- 960 Main St
Branford, CT 06405-3730 - Phone
- (203) 488-6358
- Fax
- (203) 481-5327
- NPI assigned
- Apr 13, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 042296 | CT | Primary |
Addresses
Primary practice location
960 Main St
Branford, CT 06405-3730
Mailing address
960 Main St
Branford, CT 06405-3730
Phone (203) 488-6358
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 010042296CT01 | Other | ANTHEM BCBS | |
| P00140199 | Other | RAILROAD MEDICARE | |
| 001422964 | Medicaid | CT | |
| 042296 | Other | CONNECTICARE | |
| 3680171 | Other | AETNA | |
| 0Q2728 | Other | HEALTHNET | |
| P3340613 | Other | OXFORD |
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- Other, 1991
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
960 Main St
Branford, CT 06405-3730
Phone (203) 488-6358
Hospital & facility affiliations
- Masters in Home Care, LLC
- Elara Caring
- Yale New Haven Health - Health at Home
- Yale-New Haven Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal or shaving of skin growth | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Quinnipiac Medical of Branford, LLC | Internal Medicine | Current | Accepting new patients |
Locations
960 Main St
Branford, CT 06405
Phone (203) 488-6358
Interoperability endpoints
- https://api.platform.athenahealth.com/27673/brand/1/csg/1/fhir/r4
- andrea.radebold.1@27673.direct.athenahealth.com
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.
-
- Internal Medicine Physician
- Branford, CT
- NPI 1982668240
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Rocky Hill, CT
- NPI 1679901953
-
- Home Health Agency
- Rocky Hill, CT
- NPI 1255333597
-
- Home Health Agency
- New Haven, CT
- NPI 1043217482
-
- Home Health Agency
- Milford, CT
- NPI 1407932056
-
- General Acute Care Hospital
- New Haven, CT
- NPI 1336139500
-
- General Acute Care Hospital
- New Haven, CT
- NPI 1578778726
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144886400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1643846400000",
"number": "1942264288",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "960 MAIN ST",
"city": "BRANFORD",
"state": "CT",
"postal_code": "064053730",
"telephone_number": "203-488-6358",
"fax_number": "203-481-5327"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "960 MAIN ST",
"city": "BRANFORD",
"state": "CT",
"postal_code": "064053730",
"telephone_number": "203-488-6358",
"fax_number": "203-481-5327"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RADEBOLD",
"first_name": "ANDREA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-13",
"last_updated": "2022-02-03",
"certification_date": "2022-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CT",
"license": "042296",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBS",
"identifier": "010042296CT01",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00140199",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001422964",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CONNECTICARE",
"identifier": "042296",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "3680171",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHNET",
"identifier": "0Q2728",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD",
"identifier": "P3340613",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Branford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.