Old Oak Primary Care, P.C.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

056411 Issued in CT

Legal business name

OLD OAK PRIMARY CARE, P.C.

Practice address

250 Main St S Unit G
Southbury, CT 06488-2263

Phone

(203) 533-9436

Fax

(989) 419-3050

NPI assigned

Aug 2, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Christofer John Fort, MDNPI 1366856817

Title

President

Phone

(203) 533-9436

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Old Oak Primary Care Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Christofer John Fort, M.D.

  • Internal Medicine Physician
  • Litchfield, CT
  • NPI 1366856817
  NPD (past) Authorized official

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

{
    "created_epoch": "1533168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545350400000",
    "number": "1033697859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 MAIN ST S UNIT G",
            "city": "SOUTHBURY",
            "state": "CT",
            "postal_code": "064882263",
            "telephone_number": "203-533-9436",
            "fax_number": "989-419-3050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 MAIN ST S UNIT G",
            "city": "SOUTHBURY",
            "state": "CT",
            "postal_code": "064882263",
            "telephone_number": "203-533-9436",
            "fax_number": "989-419-3050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD OAK PRIMARY CARE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-02",
        "last_updated": "2018-12-21",
        "status": "A",
        "authorized_official_last_name": "FORT",
        "authorized_official_first_name": "CHRISTOFER",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "203-533-9436",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "056411",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008073500",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Old Oak Primary Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Old Oak Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Internal Medicine Physician in Southbury, CT
• Providers in Southbury, CT by specialty
• Internal Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 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.