Individual provider Active NPI

Ken Matsuo, MD

  • Internal Medicine Physician
  • Waterbury, CT
National Provider Identifier
1053600429
Registry record updated Aug 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
53316 Issued in CT
Practice address
56 Franklin St
Waterbury, CT 06706-1253
Phone
(203) 709-8820
Fax
(203) 709-3679
NPI assigned
Apr 6, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2014

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Hospitalist Physician 208M00000X 53316 CT
Internal Medicine Physician 207R00000X 53316 CT Primary

Addresses

Primary practice location

56 Franklin St
Waterbury, CT 06706-1253

Mailing address

PO Box 1090
Windsor, CT 06095-6190
Phone (800) 925-7270

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141014000345 CT Practitioner - HospitalistPractitioner - Internal Medicine 4082834163 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hospitalist
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Galen Inpatient Physicians PCGroup PAC ID 3678464633, 1,045 clinicians

Practice addresses (Care Compare)

56 Franklin St
Waterbury, CT 06706-1253
Phone (203) 709-6000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Galen Inpatient Physicians PC Hospitalist CurrentSince Apr 7, 2025 Accepting new patients
Galen Inpatient Physicians PC Internal Medicine CurrentSince Apr 7, 2025 Accepting new patients
Trinity Health of New England Provider Network Organization Inc Internal Medicine CurrentSince Dec 19, 2021 Accepting new patients
Trinity Health of New England Provider Network Organization Inc Internal Medicine CurrentSince Dec 19, 2021 Accepting new patients

Locations

114 Woodland St
Hartford, CT 06105
Phone (860) 714-4001

Interoperability endpoints

  • Direct secure messaging: kmatsuo85105@direct.trinity-health.org

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1302048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1408320000000",
    "number": "1053600429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1090",
            "city": "WINDSOR",
            "state": "CT",
            "postal_code": "060956190",
            "telephone_number": "800-925-7270",
            "fax_number": "888-331-1015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56 FRANKLIN ST",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067061253",
            "telephone_number": "203-709-8820",
            "fax_number": "203-709-3679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATSUO",
        "first_name": "KEN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-06",
        "last_updated": "2014-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "CT",
            "license": "53316",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "53316",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterbury, CT

Sources for this page

Verify at the official NPI Registry.