NPIMap

Organization Active NPI

Fairfield County Internal Medicine and Gastroenterology Associates PC

  • Specialist
  • Bridgeport, CT
National Provider Identifier
1003849423
Registry record updated Mar 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
014919 Issued in CT
Legal business name
FAIRFIELD COUNTY INTERNAL MEDICINE AND GASTROENTEROLOGY ASSOCIATES PC
Practice address
4641 Main St Ste 1
Bridgeport, CT 06606-1827
Phone
(203) 374-4966
Fax
(203) 371-7024
NPI assigned
Jul 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2018

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

Authorized official

Name
Dr. Alan M Nelson, M.D.NPI 1720006117
Title
President
Phone
(203) 374-4966

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 015081 CT
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 014919 CT Primary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 043139 CT
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 019537 CT

Addresses

Primary practice location

4641 Main St Ste 1
Bridgeport, CT 06606-1827

Mailing address

4641 Main St Ste 1
Bridgeport, CT 06606-1827
Phone (203) 374-4966

Other identifiers 4

IdentifierTypeStateIssuer
001149194MedicaidCT
001431395MedicaidCT
001195379MedicaidCT
001150812MedicaidCT

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522108800000",
    "number": "1003849423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4641 MAIN ST STE 1",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066061827",
            "telephone_number": "203-374-4966",
            "fax_number": "203-365-6637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4641 MAIN ST STE 1",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066061827",
            "telephone_number": "203-374-4966",
            "fax_number": "203-371-7024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRFIELD COUNTY INTERNAL MEDICINE AND GASTROENTEROLOGY ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-09",
        "last_updated": "2018-03-27",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "ALAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "203-374-4966",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CT",
            "license": "015081",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CT",
            "license": "014919",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CT",
            "license": "043139",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CT",
            "license": "019537",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001149194",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001431395",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001195379",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001150812",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeport, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2018; 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.