Elissa Lane Freedman

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

050034 Issued in CT

Practice address

23 Liberty Dr
Suite a
Hebron, CT 06248-1553

Phone

(860) 228-1119

Fax

(860) 228-4314

NPI assigned

Nov 9, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Elissa Lane Newsome Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Hartford Healthcare Medical Group, Inc

  • Durable Medical Equipment & Medical Supplies
  • Farmington, CT
  • NPI 1720140221
  NPD (past)

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

{
    "created_epoch": "1194566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370995200000",
    "number": "1013197722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 LIBERTY DR",
            "address_2": "SUITE A",
            "city": "HEBRON",
            "state": "CT",
            "postal_code": "062481553",
            "telephone_number": "860-228-1119",
            "fax_number": "860-228-4314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 LIBERTY DR",
            "address_2": "SUITE A",
            "city": "HEBRON",
            "state": "CT",
            "postal_code": "062481553",
            "telephone_number": "860-228-1119",
            "fax_number": "860-228-4314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREEDMAN",
        "first_name": "ELISSA",
        "middle_name": "LANE",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-09",
        "last_updated": "2013-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CT",
            "license": "050034",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004236164",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1013197722",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELISSA",
            "last_name": "NEWSOME",
            "middle_name": "LANE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Erin Joudrey, LLC.
• Malia R Farrar, PT
• Hope Femia, APRN
• Andrew Fennell
• Alyssa Fortna, MS, OTR/L
• Pamela N. Fromme, PT
• Amanda Lee Gentile
• Kristin S. Gildersleeve, M.D.
• Yana Goral, PA-C
• Trisha D Goss, COTA/L

• All providers in Hebron, CT
• Family Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2013; 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.