NPIMap

Organization Active NPI

Intercommunity, Inc.

  • Primary Care Clinic/Center
  • East Hartford, CT
National Provider Identifier
1073548533
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
702 Issued in CT
Legal business name
INTERCOMMUNITY, INC.
Practice address
281 Main Street
East Hartford, CT 06118-1883
Phone
(860) 569-5900
Fax
(860) 569-5614
NPI assigned
Jul 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Kimberly L Beauregard, LCSW
Title
Ceo & President
Phone
(860) 569-5900

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X C0178 CT
Primary Care Clinic/Center 261QP2300X 702 CT Primary

Addresses

Primary practice location

281 Main Street
East Hartford, CT 06118-1883

Mailing address

281 Main Street
East Hartford, CT 06118-1883
Phone (860) 569-5900

Other practice location 1

16 Coventry St
Hartford, CT 06112-1524
Phone (860) 569-5900

Other identifiers 3

IdentifierTypeStateIssuer
004050993MedicaidCT
312837OtherMHN
008047966MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040329000218 CT Part B Supplier - Clinic/Group Practice 9032001649 Receives reassigned benefits from 80 practitioners
1 other NPI on this enrollment
Practice locations: East Hartford, CT; Hartford, CT; South Windsor, CT

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Intercommunity Mental H6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

16 Coventry St
Hartford, CT 06112
Phone (860) 714-3701

Practitioners & affiliated clinicians

Practitioners 145

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

View all 145

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1073548533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "281 MAIN STREET",
            "city": "EAST HARTFORD",
            "state": "CT",
            "postal_code": "061181883",
            "telephone_number": "860-569-5900",
            "fax_number": "860-569-5614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "281 MAIN STREET",
            "city": "EAST HARTFORD",
            "state": "CT",
            "postal_code": "061181883",
            "telephone_number": "860-569-5900",
            "fax_number": "860-569-5614"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16 Coventry St",
            "address_purpose": "LOCATION",
            "city": "Hartford",
            "state": "CT",
            "postal_code": "061121524",
            "country_code": "US",
            "telephone_number": "860-569-5900",
            "fax_number": "860-310-2127",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INTERCOMMUNITY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "BEAUREGARD",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO & PRESIDENT",
        "authorized_official_telephone_number": "860-569-5900",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "CT",
            "license": "C0178",
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CT",
            "license": "702",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004050993",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHN",
            "identifier": "312837",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008047966",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Hartford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.