Active NPI
Stephen J Maddox Jr., MD
- Pediatrics Physician
- Waterbury, CT
National Provider Identifier
1083680342
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 045563
- Practice address
- 160 Robbins St
Waterbury, CT 06708-2652 - Phone
- (203) 755-2999
- Fax
- (203) 755-6782
- NPI assigned
- Feb 27, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 230823 | NY | |
| Pediatrics Physician | 208000000X | 045563 | CT | Primary |
Addresses
Primary practice location
160 Robbins St
Waterbury, CT 06708-2652
Mailing address
160 Robbins St
Waterbury, CT 06708-2652
Phone (203) 755-2999
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 008016138 | Medicaid | CT | |
| 045563 | Other | CT | PHYSICIAN LICENSE |
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: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 230823 | NY | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Connecticut Children'S Specialty Group, Inc. | Pediatrics | Current | Accepting new patients |
| Connecticut Children'S Specialty Group, Inc. | Pediatrics | Current | Accepting new patients |
| Saint Raphael Faculty Physicians | Past | Accepting new patients | |
| Pediatric Assoc of Conn PC | Pediatrics | Past | Accepting new patients |
Locations
24 Hospital Ave
Danbury, CT 06810
Phone (203) 739-7118
10 Columbus Blvd
Hartford, CT 06106
Phone (860) 837-5619
282 Washington St
Hartford, CT 06106
Phone (860) 545-8950
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.
-
- Pediatrics Physician
- Hartford, CT
- NPI 1669448882
-
- Ophthalmology Physician
- Glastonbury, CT
- NPI 1568056984
Pediatrics
-
- Pediatrics Physician
- Waterbury, CT
- NPI 1376505859
-
- Internal Medicine Physician
- New Haven, CT
- NPI 1932138138
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140998400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1455148800000",
"number": "1083680342",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "160 ROBBINS ST",
"city": "WATERBURY",
"state": "CT",
"postal_code": "067082652",
"telephone_number": "203-755-2999",
"fax_number": "203-755-6782"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "160 ROBBINS ST",
"city": "WATERBURY",
"state": "CT",
"postal_code": "067082652",
"telephone_number": "203-755-2999",
"fax_number": "203-755-6782"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADDOX",
"first_name": "STEPHEN",
"middle_name": "J",
"name_suffix": "Jr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-27",
"last_updated": "2016-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NY",
"license": "230823",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CT",
"license": "045563",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "008016138",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHYSICIAN LICENSE",
"identifier": "045563",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Waterbury, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.