NPIMap

Individual provider Active NPI

Michael Connolly

  • Psychiatry Physician
  • Farmington, CT
National Provider Identifier
1003303181
Registry record updated May 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
66994 Issued in CT
Practice address
263 Farmington Ave
Farmington, CT 06030-1921
Phone
(860) 679-4733
Fax
(860) 679-1316
NPI assigned
Apr 16, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2021

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
Psychiatry Physician 2084P0800X 66994 CT Primary

Addresses

Primary practice location

263 Farmington Ave
Farmington, CT 06030-1921

Mailing address

263 Farmington Ave
Farmington, CT 06030-1921
Phone (860) 679-2147

Other practice location 1

189 Storrs Rd
Mansfield Center, CT 06250-1683
Phone (860) 456-1311

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
I20210107001855 CT Practitioner - Psychiatry 3173872546 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
State of Connecticut 267 clinicians

Practice addresses (Care Compare)

1000 Silver St
Middletown, CT 06457-3940
Phone (860) 262-5000

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
State of Connecticut CurrentSince Oct 29, 2022 Accepting new patients
State of Connecticut CurrentSince Oct 29, 2022 Accepting new patients

Locations

263 Farmington Ave
Farmington, CT 06030
Phone (860) 679-4477

263 Farmington Ave
#68
Farmington, CT 06030
Phone (860) 679-6296

450 Columbus Blvd
Ste 1001
Hartford, CT 06103

Interoperability endpoints

  • Direct secure messaging: michael.connolly@xdr.hhchealthdirect.org

Organizations & group practices 11

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

NPI Registry JSON

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

{
    "created_epoch": "1523836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620950400000",
    "number": "1003303181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "263 FARMINGTON AVE",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060301921",
            "telephone_number": "860-679-2147",
            "fax_number": "860-679-4624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "263 FARMINGTON AVE",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060301921",
            "telephone_number": "860-679-4733",
            "fax_number": "860-679-1316"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "189 Storrs Rd",
            "address_purpose": "LOCATION",
            "city": "Mansfield Center",
            "state": "CT",
            "postal_code": "062501683",
            "country_code": "US",
            "telephone_number": "860-456-1311",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CONNOLLY",
        "first_name": "MICHAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-16",
        "last_updated": "2021-05-14",
        "certification_date": "2021-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CT",
            "license": "66994",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, CT

Sources for this page

Verify at the official NPI Registry.