Individual provider Active NPI

Michael John Dewberry, MD

  • Psychiatry Physician
  • Manchester, CT
National Provider Identifier
1053574442
Registry record updated Feb 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
049015 Issued in CT
Practice address
444 Center St
Manchester, CT 06040-3926
Phone
(860) 646-3888
Fax
(860) 645-4132
NPI assigned
Jul 7, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 049015 CT Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

444 Center St
Manchester, CT 06040-3926

Mailing address

995 Day Hill Rd
Windsor, CT 06095-1722
Phone (860) 731-5522

Other identifiers 1

IdentifierTypeStateIssuer
001490150MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101027000315 CT Practitioner - Psychiatry 3870787500 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
92.63 of 100Reported as group
Quality
75.35
Promoting interoperability
100
Improvement activities
40
Cost
71.44

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
049015CTMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hartford Hospital Psychiatry CurrentSince Jul 23, 2010 Accepting new patients
Community Health Resources, Inc CurrentSince Feb 13, 2017 Accepting new patients
Community Health Resources, Inc. CurrentSince Feb 13, 2017 Accepting new patients
Hartford Hospital CurrentSince Jul 23, 2010 Accepting new patients
Natchaug Hospital, Inc. Past Accepting new patients

Locations

693 Bloomfield Ave
Bloomfield, CT 06002
Phone (860) 242-8427

153 Hazard Ave
Enfield, CT 06082
Phone (860) 253-5020

282 Washington St
Hartford, CT 06106
Phone (860) 545-8950

444 Center St
Manchester, CT 06040
Phone (860) 646-3888

31 Union St
Vernon Rockvl, CT 06066
Phone (860) 289-6451

2 Waterside Xing
Ste 401
Windsor, CT 06095

995 Day Hill Rd
Windsor, CT 06095
Phone (860) 697-3351

Interoperability endpoints

  • Direct secure messaging: michael.dewberry@xdr.hhchealthdirect.org

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1215388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486339200000",
    "number": "1053574442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "995 DAY HILL RD",
            "city": "WINDSOR",
            "state": "CT",
            "postal_code": "060951722",
            "telephone_number": "860-731-5522",
            "fax_number": "860-731-5536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "444 CENTER ST",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060403926",
            "telephone_number": "860-646-3888",
            "fax_number": "860-645-4132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEWBERRY",
        "first_name": "MICHAEL",
        "middle_name": "JOHN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-07",
        "last_updated": "2017-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CT",
            "license": "049015",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001490150",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, CT

Sources for this page

Verify at the official NPI Registry.