MEDICARE: PRIMED LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician
3	207RG0100X	Gastroenterology Physician
4	207RC0000X	Cardiovascular Disease Physician
5	207RG0300X	Geriatric Medicine (Internal Medicine) Physician
6	207Q00000X	Family Medicine Physician
7	208000000X	Pediatrics Physician
8	208600000X	Surgery Physician
9	363L00000X	Nurse Practitioner
10	207RC0200X	Critical Care Medicine (Internal Medicine) Physician
11	207RP1001X	Pulmonary Disease Physician
12	207RS0012X	Sleep Medicine (Internal Medicine) Physician
13	213E00000X	Podiatrist	000462	CT
14	207W00000X	Ophthalmology Physician
15	207R00000X	Internal Medicine Physician	025538	CT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	470000038	OTHER	CT	MEDICARE FCSC

General Provider Information

NPI Number	:	1023055530
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMED LLC

Provider Business Mailing Address
First Line	:	3 ENTERPRISE DR
Second Line	:	SUITE 404
City	:	SHELTON
State	:	CT
Zip	:	06484-4694
Country	:	US
Telephone Number	:	203-944-1940
Fax Number	:	203-402-4196

Provider Business Practice Location Address
First Line	:	4699 MAIN ST
Second Line	:	SUITE 105 ATTN: MED3000
City	:	BRIDGEPORT
State	:	CT
Zip	:	06606-1830
Country	:	US
Telephone Number	:	203-944-1940
Fax Number	:	203-402-4196

Authorized Official
Title or Position	:	PRESIDENT, PRIMED LLC
Name	:	DR. AMIT RASTOGI
Credential	:	MD
Telephone Number	:	203-944-1940

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	03/27/2013

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Directions to “PRIMED LLC ” Practice Location

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