NPIMap

Individual provider Active NPI

Jeffrey Mark Kagan, M.D.

  • Internal Medicine Physician
  • Newington, CT
National Provider Identifier
1003886193
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
030937 Issued in CT
Practice address
365 Willard Ave
Suite 2-D
Newington, CT 06111-2373
Phone
(860) 665-1571
Fax
(860) 667-3668
NPI assigned
Jan 23, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 030937 CT Primary

Addresses

Primary practice location

365 Willard Ave
Suite 2-D
Newington, CT 06111-2373

Mailing address

365 Willard Ave
Suite 2-D
Newington, CT 06111-2373
Phone (860) 665-1571

Other identifiers 1

IdentifierTypeStateIssuer
001309378MedicaidCT

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
I20100212000391 CT Practitioner - Internal MedicinePractitioner - Hospice/Palliative Care 1850318049 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Hospice/Palliative Care
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Hartford Healthcare Medical Group Specialists PLLCGroup PAC ID 3173866241, 1,555 clinicians

Practice addresses (Care Compare)

1244 Storrs Rd
Road
Storrs, CT 06268-2200
Phone (860) 724-2579

365 Willard Ave
Newington, CT 06111-2373
Phone (860) 665-1274

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.48 of 100Reported as apm
Quality
83.4
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
90.42 of 100Reported as group
Quality
83.36
Promoting interoperability
100
Improvement activities
40
Cost
75.9

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
030937CTMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hartford Healthcare Medical Group Specialists, PLLC CurrentSince Apr 1, 2020 Accepting new patients
Hartford Healthcare Medical Group, Inc Internal Medicine CurrentSince Jan 6, 2020 Accepting new patients
Hartford Healthcare Medical Group Specialists LLC CurrentSince Apr 1, 2020 Accepting new patients

Locations

365 Willard Ave
Ste 2D
Newington, CT 06111
Phone (860) 229-4183

55 Meriden Ave
Ste 1D
Southington, CT 06489
Phone (860) 276-5144

1244 Storrs Rd
Storrs Mansfield, CT 06268
Phone (860) 724-2579

1290 Silas Deane Hwy
Wethersfield, CT 06109
Phone (860) 972-6977

Interoperability endpoints

  • Direct secure messaging: jeffrey.kagan.1@27899.direct.athenahealth.com
  • Direct secure messaging: jeffrey.kagan@xdr.hhchealthdirect.org

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Civita Care Center at NewingtonNewington, CT, CCN 075286 Skilled nursing facility Adp of the SNF Oct 1, 2024

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

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

Hospital & facility affiliations 9

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": "1137974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1003886193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "365 WILLARD AVE",
            "address_2": "SUITE 2-D",
            "city": "NEWINGTON",
            "state": "CT",
            "postal_code": "061112373",
            "telephone_number": "860-665-1571",
            "fax_number": "860-667-3668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "365 WILLARD AVE",
            "address_2": "SUITE 2-D",
            "city": "NEWINGTON",
            "state": "CT",
            "postal_code": "061112373",
            "telephone_number": "860-665-1571",
            "fax_number": "860-667-3668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAGAN",
        "first_name": "JEFFREY",
        "middle_name": "MARK",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "030937",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001309378",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newington, CT

Sources for this page

Verify at the official NPI Registry.