Digestive Disease Associates Endoscopy Suite, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

0322 Issued in CT

Legal business name

DIGESTIVE DISEASE ASSOCIATES ENDOSCOPY SUITE, LLC

Practice address

687 Main St
Branford, CT 06405-3612

Phone

(203) 481-0315

Fax

(203) 488-6945

NPI assigned

Dec 2, 2008

Organization subpart

No

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

Authorized official

Name

Christopher Dunbar IllickNPI 1609836998

Title

Partner

Phone

(203) 481-0315

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Listed as

Digestive Disease Associates Endoscopy Suite LLCCCN 07C0001054

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 8

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

• Kenneth Barshop, M.D.

  • Gastroenterology Physician
  • Branford, CT
  • NPI 1316396690
  Medicare reassignment NPD
• Kristin Loening Macarthur, M.D.

  • Gastroenterology Physician
  • Branford, CT
  • NPI 1225357809
  Medicare reassignment NPD
• Daniel Joseph Zanchetti, M.D.

  • Gastroenterology Physician
  • New Haven, CT
  • NPI 1821257742
  Medicare reassignment NPD
• Christopher Dunbar Illick, MD

  • Gastroenterology Physician
  • Branford, CT
  • NPI 1609836998
  NPD Authorized official
• Michael Phillip Dorfman, M.D.

  • Gastroenterology Physician
  • Branford, CT
  • NPI 1164658555
  NPD
• Keri Alissa Herzog, M.D.

  • Gastroenterology Physician
  • Branford, CT
  • NPI 1427292614
  NPD
• Nadeen Hussain, MD

  • Internal Medicine Physician
  • Bradford, CT
  • NPI 1336705524
  NPD
• Michael Schultz, PA

  • Medical Physician Assistant
  • New Haven, CT
  • NPI 1396727533
  NPD

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

{
    "created_epoch": "1228176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646352000000",
    "number": "1972758183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "687 MAIN ST",
            "city": "BRANFORD",
            "state": "CT",
            "postal_code": "064053612",
            "telephone_number": "203-481-0315",
            "fax_number": "203-488-6945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "687 MAIN ST",
            "city": "BRANFORD",
            "state": "CT",
            "postal_code": "064053612",
            "telephone_number": "203-481-0315",
            "fax_number": "203-488-6945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIGESTIVE DISEASE ASSOCIATES ENDOSCOPY SUITE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-02",
        "last_updated": "2022-03-04",
        "certification_date": "2022-03-04",
        "status": "A",
        "authorized_official_last_name": "ILLICK",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "DUNBAR",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "203-481-0315"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CT",
            "license": "0322",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CCN       CENTERS FOR MEDICARE AND MEDICAID SERVICES CERTIFICATION NUMBER",
            "identifier": "07C0001054",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heather Desroches, PA
• Susan Devlin, OTR
• Brett David Devries, PA-C
• Diabetic Footwear Centers LLC
• Vincent J Difonzo, MPT
• Digestive Disease Associates, LLC
• Kristy Dillon, MSW
• Carlene Dinitto, COTA
• Joanna Dinkle, LCSW
• Claire Dinorscia, RPH

• Ambulatory Surgical Clinic/Center in Branford, CT
• Providers in Branford, CT by specialty
• Ambulatory Surgical Clinic/Center in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.

Verify at the official NPI Registry.