NPIMap

Individual provider Active NPI

Kevin Jo, M.D.

  • Gastroenterology Physician
  • Meriden, CT
National Provider Identifier
1003823683
Registry record updated Jun 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
050624 Issued in CT
Practice address
455 Lewis Ave
Suite 106
Meriden, CT 06451-2121
Phone
(203) 886-0036
Fax
(203) 886-0072
NPI assigned
Aug 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 239729 NY
Gastroenterology Physician 207RG0100X 050624 CT Primary

Addresses

Primary practice location

455 Lewis Ave
Suite 106
Meriden, CT 06451-2121

Mailing address

2139 Silas Deane Hwy # H
Rocky Hill, CT 06067-2336
Phone (860) 257-4131

Other identifiers 1

IdentifierTypeStateIssuer
008039309MedicaidCT

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
I20120417000609 CT Practitioner - GastroenterologyPractitioner - Internal Medicine 7517013337 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
Vanderbilt University School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Connecticut Gi PLLCGroup PAC ID 9830110758, 243 clinicians

Practice addresses (Care Compare)

55 Meriden Ave
2C
Southington, CT 06489-3235
Phone (860) 621-6284

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.99 of 100Reported as group
Quality
89.16
Promoting interoperability
100
Improvement activities
40
Cost
78.45

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy88
Upper gastrointestinal (GI) endoscopy for acid reflux56

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
050624CTMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Connecticut Gi PLLC Gastroenterology CurrentSince May 1, 2012 Accepting new patients
Hartford Hospital CurrentSince Jun 1, 2014 Accepting new patients
Wallingford Endoscopy Center, LLC. Current Accepting new patients
Hartford Hospital CurrentSince Jun 1, 2014 Accepting new patients
Internal Medicine Associates, P.C. Gastroenterology Past Accepting new patients
Litchfield County Gastroenterology Associates, LLC Gastroenterology Past Accepting new patients

Locations

85 Seymour St
Ste 1000
Hartford, CT 06106
Phone (860) 246-2571

455 Lewis Ave
Ste 200
Meriden, CT 06451
Phone (203) 238-9446

30 Waterchase Dr
Rocky Hill, CT 06067
Phone (860) 257-4131

55 Meriden Ave
Ste 2C
Southington, CT 06489
Phone (860) 621-6284

Interoperability endpoints

  • Direct secure messaging: kevin.jo@xdr.hhchealthdirect.org

Organizations & group practices 6

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.

Hospital & facility affiliations 6

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": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338508800000",
    "number": "1003823683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2139 SILAS DEANE HWY # H",
            "city": "ROCKY HILL",
            "state": "CT",
            "postal_code": "060672336",
            "telephone_number": "860-257-4131",
            "fax_number": "860-257-4519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 LEWIS AVE",
            "address_2": "SUITE 106",
            "city": "MERIDEN",
            "state": "CT",
            "postal_code": "064512121",
            "telephone_number": "203-886-0036",
            "fax_number": "203-886-0072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JO",
        "first_name": "KEVIN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-03",
        "last_updated": "2012-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NY",
            "license": "239729",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "CT",
            "license": "050624",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008039309",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Meriden, CT

Sources for this page

Verify at the official NPI Registry.