NPIMap

Individual provider Active NPI

Slava I Kulakov, MD

  • Internal Medicine Physician
  • Fairfield, CT
National Provider Identifier
1073524104
Registry record updated Jun 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036896 Issued in CT
Practice address
134 Round Hill Rd
Fairfield, CT 06824
Phone
(203) 255-0695
Fax
(203) 255-0629
NPI assigned
Aug 11, 2006
Last updated
Jun 25, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2019

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 036896 CT Primary

Addresses

Primary practice location

134 Round Hill Rd
Fairfield, CT 06824

Mailing address

765 Main St
Ste 100
Monroe, CT 06468-2810
Phone (203) 255-0695

Other identifiers 3

IdentifierTypeStateIssuer
010036896CT01OtherCTBCBS
001368960MedicaidCT
OV4890OtherCTHEALTHNET

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
I20100920000212 CT Practitioner - Internal MedicinePractitioner - Preventive Medicine 1951491158 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Preventive Medicine
Education
Other, 1987
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
Rehabilitation Associates IncGroup PAC ID 8022905322, shared by 2 NPIs, 525 clinicians

Practice addresses (Care Compare)

130 Division St
Derby, CT 06418-1326
Phone (203) 648-4779

1931 Black Rock Tpke
Fairfield, CT 06825-3506
Phone (203) 384-8681

Hospital & facility affiliations

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
036896CTMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hartford Healthcare Medical Group Specialists, PLLC CurrentSince Jul 29, 2019 Accepting new patients
Northeast Medical Group, Inc. Internal Medicine CurrentSince Jun 1, 2014 Accepting new patients
Hartford Healthcare Medical Group Specialists LLC CurrentSince Jul 29, 2019 Accepting new patients
Molloy, Dafcik & Kulakov L.L.C Internal Medicine PastSince Jul 30, 2001 Accepting new patients

Locations

2800 Main St
Bridgeport, CT 06606
Phone (203) 386-0366

130 Division St
Derby, CT 06418
Phone (203) 732-1330

1055 Post Rd
Fairfield, CT 06824
Phone (203) 254-1055

134 Round Hill Rd
Ste 2
Fairfield, CT 06824
Phone (203) 255-0695

525 Tunxis Hill Cut Off
Fairfield, CT 06825
Phone (203) 557-8200

765 Main St
Ste 100
Monroe, CT 06468
Phone (914) 844-5428

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

95 Armory Rd
Stratford, CT 06614
Phone (203) 384-3388

112 Quarry Rd
Ste 150
Trumbull, CT 06611
Phone (203) 385-1166

888 White Plains Rd
Ste 203
Trumbull, CT 06611
Phone (203) 459-0408

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

Interoperability endpoints

  • Direct secure messaging: slava.kulakov@xdr.hhchealthdirect.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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1155254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561420800000",
    "number": "1073524104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "765 MAIN ST",
            "address_2": "STE 100",
            "city": "MONROE",
            "state": "CT",
            "postal_code": "064682810",
            "telephone_number": "203-255-0695",
            "fax_number": "203-255-0629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 ROUND HILL RD",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "06824",
            "telephone_number": "203-255-0695",
            "fax_number": "203-255-0629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KULAKOV",
        "first_name": "SLAVA",
        "middle_name": "I",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-11",
        "last_updated": "2019-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "036896",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "010036896CT01",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001368960",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "OV4890",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfield, CT

Sources for this page

Verify at the official NPI Registry.