NPIMap

Organization Active NPI

Main Medical-Mystic, LLC

  • Internal Medicine Physician
  • Mystic, CT
National Provider Identifier
1003001850
Registry record updated Sep 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
031865 Issued in CT
Legal business name
MAIN MEDICAL-MYSTIC, LLC
Practice address
23 Clara Dr
Suite 201
Mystic, CT 06355-1959
Phone
(860) 536-1666
Fax
(860) 536-9770
NPI assigned
Sep 13, 2007
Last updated
Sep 13, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2007

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

Authorized official

Name
Dr. Roy Martin Main, M.D.
Title
Owner/Physician
Phone
(860) 536-1666

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X 031865 CT Primary

Addresses

Primary practice location

23 Clara Dr
Suite 201
Mystic, CT 06355-1959

Mailing address

23 Clara Dr
Suite 201
Mystic, CT 06355-1959
Phone (860) 536-1666

National Provider Directory

National Provider Directory

Locations

23 Clara Dr
Ste 201
Mystic, CT 06355
Phone (860) 536-1666

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1189641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189641600000",
    "number": "1003001850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 CLARA DR",
            "address_2": "SUITE 201",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "063551959",
            "telephone_number": "860-536-1666",
            "fax_number": "860-536-9770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 CLARA DR",
            "address_2": "SUITE 201",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "063551959",
            "telephone_number": "860-536-1666",
            "fax_number": "860-536-9770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN MEDICAL-MYSTIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-13",
        "last_updated": "2007-09-13",
        "status": "A",
        "authorized_official_last_name": "MAIN",
        "authorized_official_first_name": "ROY",
        "authorized_official_middle_name": "MARTIN",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "860-536-1666",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "031865",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mystic, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.