Matthew Nichols
Individual provider Active NPI Family Medicine Physician · Portland, CT
NPI 1093028052 · NPPES record last updated Apr 11, 2017
Key facts
- NPI
- 1093028052
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 051299 (CT)
- Practice address
- 270 Main St
Portland, CT 06480-1859 - Phone
- (860) 342-3392
- Fax
- (860) 358-8658
- NPI assigned
- Jul 20, 2010
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Hospitalist
- Education
- State University of New York at Buffalo School of Medicine, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- MHS Primary Care, Inc.
Practice addresses (Care Compare)
270 Main St
Suite a
Portland, CT 06480-1836
Phone (860) 358-5040
Hospital & facility affiliations
- Middlesex Health Care at Home and Hospice Program
- Middlesex Health Care at Home & Hospice Program
- Middlesex Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130716000769 | CT | Practitioner - Hospitalist | 8426298324 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051299 | CT | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Middlesex Hospital | Family Medicine | Current |
Accepting new patients |
| MHS Primary Care | Family Medicine | Current |
Accepting new patients |
| Middlesex Hospital | Family Medicine | Current |
Accepting new patients |
| MHS Primary Care, Inc | Family Medicine | Current | Accepting new patients |
| MHS Primary Care Inc | Family Medicine | Current |
Accepting new patients |
Locations
80 S Main St
Ste 102
Middletown, CT 06457
Phone (860) 358-6878
28 Crescent St
Middletown, CT 06457
Phone (860) 358-6000
270 Main St
Portland, CT 06480
Phone (860) 342-3392
270 Main St
Ste A
Portland, CT 06480
Phone (860) 358-5040
Interoperability endpoints
- mnichols9776@middlesexhealthprd.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 051299 | CT | Yes |
Addresses
Primary practice location
270 Main St
Portland, CT 06480-1859
Mailing address
28 Crescent St
Middletown, CT 06457-3654
Phone (860) 358-4820
Other providers in Portland, CT
- Kristen Coffey Moran-Dillon
- John Louis Mormile
- Richard Brian Morse
- Kelly Marie Mullen
- Louis R Neumann
- Sara Oconnell
- Carly M Odesina
- Jennifer Owens
- Rupesh Pandey
- Stephen P Paschall
All providers in Portland, CT · Family Medicine Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 11, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.