NPIMap

Individual provider Active NPI

Colleen Sherkow, M.D.

  • Internal Medicine Physician
  • Wallingford, CT
National Provider Identifier
1073755534
Registry record updated Dec 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
051464 Issued in CT
Practice address
863 N Main Street Ext
Suite 103
Wallingford, CT 06492-2434
Phone
(203) 694-5500
Fax
(203) 694-5520
NPI assigned
Mar 30, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2013

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 051464 CT Primary

Addresses

Primary practice location

863 N Main Street Ext
Suite 103
Wallingford, CT 06492-2434

Mailing address

863 N Main Street Ext
Suite 103
Wallingford, CT 06492-2434
Phone (203) 694-5500

Other identifiers 2

IdentifierTypeStateIssuer
008046671MedicaidCT
1073755534OtherCTANTHEM BCBS

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
I20140127001607 CT Practitioner - Internal Medicine 3375772114 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Wisconsin School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Hartford Healthcare Medical Group IncGroup PAC ID 1153573902, 257 clinicians

Practice addresses (Care Compare)

55 Meriden Ave
Suite 1D
Southington, CT 06489-3239
Phone (860) 276-5144

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.48 of 100Reported as apm
Quality
83.4
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
051464CTMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hartford Healthcare Medical Group, Inc Internal Medicine CurrentSince Sep 23, 2013 Accepting new patients
Hartford Healthcare Medical Group, Inc Past Accepting new patients

Locations

55 Meriden Ave
Ste 1D
Southington, CT 06489
Phone (860) 276-5144

863 N Main Street Ext
Ste 103
Wallingford, CT 06492
Phone (203) 694-5500

Interoperability endpoints

  • Direct secure messaging: colleen.sherkow@xdr.hhchealthdirect.org

Organizations & group practices 2

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 9

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": "1238371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1387152000000",
    "number": "1073755534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "863 N MAIN STREET EXT",
            "address_2": "SUITE 103",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064922434",
            "telephone_number": "203-694-5500",
            "fax_number": "203-694-5520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "863 N MAIN STREET EXT",
            "address_2": "SUITE 103",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064922434",
            "telephone_number": "203-694-5500",
            "fax_number": "203-694-5520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHERKOW",
        "first_name": "COLLEEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-30",
        "last_updated": "2013-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "051464",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008046671",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "1073755534",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wallingford, CT

Sources for this page

Verify at the official NPI Registry.