NPIMap

Organization Active NPI

Potomac Health of Wisconsin PC

  • Orthopaedic Surgery Physician
  • Stamford, CT
National Provider Identifier
1083322135
Registry record updated Nov 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
POTOMAC HEALTH OF WISCONSIN PC
Practice address
1177 High Ridge Rd
Stamford, CT 06905-1221
Phone
(201) 834-4786
NPI assigned
Nov 8, 2022
Organization subpart
Yes
Parent organization
POTOMAC HEALTH PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 8, 2022

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

Authorized official

Name
Jay A Kimmel
Title
Chief Medical Officer
Phone
(860) 728-6740

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X Primary

Addresses

Primary practice location

1177 High Ridge Rd
Stamford, CT 06905-1221

Mailing address

1177 High Ridge Rd
Stamford, CT 06905-1221

National Provider Directory

National Provider Directory
Tax ID family
Potomac Health PC17 organizations share this tax ID, including this one
Part of
Potomac Health PC

Other organizations with this tax ID 16

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

View all 16

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1667865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667865600000",
    "number": "1083322135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1177 HIGH RIDGE RD",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069051221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1177 HIGH RIDGE RD",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069051221",
            "telephone_number": "201-834-4786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTOMAC HEALTH OF WISCONSIN PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "POTOMAC HEALTH PC",
        "enumeration_date": "2022-11-08",
        "last_updated": "2022-11-08",
        "certification_date": "2022-11-08",
        "status": "A",
        "authorized_official_last_name": "KIMMEL",
        "authorized_official_first_name": "JAY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "860-728-6740"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stamford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.