Individual provider Active NPI

Stephen J Maddox Jr., MD

  • Pediatrics Physician
  • Waterbury, CT
National Provider Identifier
1083680342
Registry record updated Feb 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
045563 Issued in CT
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

Updated by the provider on Feb 11, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
008016138MedicaidCT
045563OtherCTPHYSICIAN 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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070727000243 CT Practitioner - Pediatric Medicine 8022088194 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
230823NYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Connecticut Children'S Specialty Group, Inc. Pediatrics CurrentSince Apr 21, 2018 Accepting new patients
Connecticut Children'S Specialty Group, Inc. Pediatrics CurrentSince Apr 21, 2018 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.

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

Verify at the official NPI Registry.