NPIMap

Individual provider Active NPI

Sandeep Tiyyagura, MD

  • Nephrology Physician
  • Waterbury, CT
National Provider Identifier
1982882882
Registry record updated Oct 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
048549 Issued in CT
Practice address
140 Grandview Ave
Suite 101
Waterbury, CT 06708-2505
Phone
(203) 597-9733
Fax
(203) 597-9732
NPI assigned
Feb 4, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 20, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Nephrology Physician 207RN0300X 048549 CT Primary

Addresses

Primary practice location

140 Grandview Ave
Suite 101
Waterbury, CT 06708-2505

Mailing address

140 Grandview Ave
Suite 101
Waterbury, CT 06708-2505
Phone (203) 597-9733

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100721000823 CT Practitioner - NephrologyPractitioner - Internal Medicine 5991837239 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Connecticut Kidney and Hypertension Specialists, LLCGroup PAC ID 7315090735, 6 clinicians
Staywell Health Care Inc.Group PAC ID 6305750480, 43 clinicians

Practice addresses (Care Compare)

140 Grandview Ave
Suite 101
Waterbury, CT 06708-2518
Phone (203) 597-9733

80 Phoenix Ave
Waterbury, CT 06702-1418
Phone (203) 757-5491

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
19.97 of 100Reported as individual
Quality
0
Improvement activities
0
Cost
66.56

National Provider Directory

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

Interoperability endpoints

  • Direct secure messaging: stiyyagura@direct.wtbyhosp.org

Organizations & group practices 2

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

Hospital & facility affiliations 5

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": "1202083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287532800000",
    "number": "1982882882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 GRANDVIEW AVE",
            "address_2": "SUITE 101",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067082505",
            "telephone_number": "203-597-9733",
            "fax_number": "203-597-9732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 GRANDVIEW AVE",
            "address_2": "SUITE 101",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067082505",
            "telephone_number": "203-597-9733",
            "fax_number": "203-597-9732"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIYYAGURA",
        "first_name": "SANDEEP",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-02-04",
        "last_updated": "2010-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CT",
            "license": "048549",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterbury, CT

Sources for this page

Verify at the official NPI Registry.