1. Home
  2. Directory
  3. Connecticut
  4. East Granby
  5. Family Medicine
  6. NPI Profile

EAST GRANBY FAMILY PRACTICE LLC
NPI 1154308229
Family Medicine in East Granby, CT

Active since December 29, 2005CLIA 07D0092457 · Microscopy
13 CHURCH RD, EAST GRANBY, CT 06026(860) 653-4526(860) 653-5209 Get Directions Write a Review

NPPES record last updated: June 26, 2013. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About East Granby Family Practice Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EAST GRANBY FAMILY PRACTICE LLC (NPI 1154308229) is a healthcare organization registered as a family medicine in East Granby, Connecticut and active in the NPI registry since December 2005. The organization holds a CLIA Microscopy certificate valid through May 12, 2027 and lists Steven R Dietrich, Partner Md, as its authorized official.

NPPES Registry Identity

NPI1154308229
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameEAST GRANBY FAMILY PRACTICE LLC
Location Address13 CHURCH RDEast Granby, CT 06026-0518
Mailing Address13 Church Rd, Po Box 518East Granby, CT 06026-0518 · (860) 653-4526 · Fax (860) 653-5209
Phone(860) 653-4526
Fax(860) 653-5209
Organization SubpartNo
Authorized OfficialSteven R DietrichPartner Md · (860) 653-4526
Enumeration DateDecember 29, 2005
Last NPPES UpdateJune 26, 2013
✔ NPI 1154308229 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X
13 CHURCH RD, East Granby, CT 06026
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

East Granby Family Practice Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

13

Medicare enrollment records show 13 clinicians reassign Medicare billing to East Granby Family Practice LLC, which bills Medicare for the services they deliver. Of these, 8 practice at this address and 12 within 10 miles. They are listed nearest first.

Clinicians by Medicare Specialty 2

Family Practice9
Nurse Practitioner4

Clinicians, nearest first (13)

Elizabeth Freedman, MD
Family Practice
NPI 1154308211
13 CHURCH RD
East Granby, CT 06026
(860) 653-4526
✔ PECOS✔ Accepts MedicareSame address
David Howlett, MD
Family Practice
NPI 1760469829
13 CHURCH RD
East Granby, CT 06026
(860) 653-4526
✔ PECOS✔ Accepts MedicareSame address
Kerri Anderson, APRN
Nurse Practitioner
NPI 1992267660
13 CHURCH RD
East Granby, CT 06026
(860) 653-4526
✔ PECOS✔ Accepts MedicareSame address
Ellen Maurus
Nurse Practitioner
NPI 1316673452
13 CHURCH RD
East Granby, CT 06026
(860) 653-4526
✔ PECOS✔ Accepts MedicareSame address
Tejal Shaikh, D.O.
Family Practice
NPI 1508312893
13 CHURCH RD
East Granby, CT 06026
(860) 653-4526
✔ PECOS✔ Accepts MedicareSame address
Kimberly Davis, DO
Family Practice
NPI 1639791379
13 CHURCH RD
East Granby, CT 06026
(860) 653-4526
✔ PECOS✔ Accepts MedicareSame address
Edward Ewald, MD
Family Practice
NPI 1497732564
13 CHURCH RD
East Granby, CT 06026
(860) 653-4526
✔ PECOS✔ Accepts MedicareSame address
Madeline Mondo
Nurse Practitioner
NPI 1558220319
13 CHURCH RD
East Granby, CT 06026
(860) 653-4526
✔ PECOS✔ Accepts MedicareSame address
Khuram Ghumman, MD, MPH, CPE, FAAFP
Family Practice
NPI 1447384326
13 CHURCH ST
East Granby, CT 06026
(860) 653-4526
✔ PECOS✔ Accepts Medicare0.1 mi
Alina Kluk, MD
Family Practice
NPI 1063032977
13 CHURCH STREET
East Granby, CT 06026
(860) 653-4526
✔ PECOS✔ Accepts Medicare0.1 mi
Daniel Lerner, D.O.
Family Practice
NPI 1700222817
13 CHURCH ST
East Granby, CT 06026
(860) 653-4526
✔ PECOS✔ Accepts Medicare0.1 mi
Neena Pursnani, MD
Family Practice
NPI 1306871355
851 MARSHALL PHELPS RD HEALTHONE WINDSOR FAMILY MEDICINE
Windsor, CT 06095
(860) 683-0756
✔ PECOS✔ Accepts Medicare5.7 mi
Anna Rodis, APRN, AGPCNP-BC
Nurse Practitioner
NPI 1700534401
100 S JUNIPER ST FL 3
Philadelphia, PA 19107
(866) 849-0692
✔ PECOS✔ Accepts Medicare188 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 07D0092457

East Granby Family Practice LLC · East Granby, CT
Active · expires May 12, 2027
CLIA Number07D0092457
Laboratory TypePhysician Office
Certificate Effective DateMay 13, 2025
Certificate Expiration DateMay 12, 2027
Laboratory DirectorDavid R. Howlett
Laboratory Phone(203) 653-4526
Laboratory LocationEast Granby Family Practice LLC13 Church Road, East Granby, CT 06026
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is East Granby Family Practice LLC's NPI number?

The NPI number for East Granby Family Practice LLC is 1154308229. It was assigned to this organization in the NPPES registry on December 29, 2005.

Where is East Granby Family Practice LLC located?

East Granby Family Practice LLC is located at 13 Church Rd, East Granby, CT 06026. The listed phone number is (860) 653-4526.

What is East Granby Family Practice LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is East Granby Family Practice LLC enrolled in Medicare?

Yes. East Granby Family Practice LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through East Granby Family Practice LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 13 clinicians in 2 Medicare specialties reassign their Medicare billing to East Granby Family Practice LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Family Practice (9) and Nurse Practitioner (4). Of these, 8 practice at this address and 12 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does East Granby Family Practice LLC hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 07D0092457) is associated with this NPI, valid through May 12, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for East Granby Family Practice LLC was last updated on June 26, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.