Active NPI
Robert Connelly, M.D.
- Internal Medicine Physician
- Brookfield, CT
National Provider Identifier
1093754590
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 65250
- Practice address
- 401 Federal Rd
Brookfield, CT 06804-2037 - Phone
- (203) 775-6365
- Fax
- (203) 740-3010
- NPI assigned
- Jun 6, 2006
- Last updated
- Aug 12, 2020
- 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 |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 036-109804 | IL | |
| Internal Medicine Physician | 207R00000X | 65250 | CT | Primary |
Addresses
Primary practice location
401 Federal Rd
Brookfield, CT 06804-2037
Mailing address
1913 W North Ave
Chicago, IL 60622-1316
Other practice location 1
75 Remittance Dr
Suite 1293
Chicago, IL 60675-1293
Phone (312) 926-3642
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036-109804 | Medicaid | IL |
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
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
401 Federal Rd
Brookfield, CT 06804-2037
Phone (203) 775-6365
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 65250 | CT | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nuvance Health Medical Practice CT, Inc. | Internal Medicine | Current | Accepting new patients |
| Northwestern Memorial Physicians Group | Internal Medicine | Past | Accepting new patients |
Locations
401 Federal Rd
Brookfield, CT 06804
Phone (203) 775-6365
24 Hospital Ave
Danbury, CT 06810
Phone (203) 739-7118
22 Old Waterbury Rd
Southbury, CT 06488
Phone (203) 262-4200
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Internal Medicine Physician
- Danbury, CT
- NPI 1407898117
-
dba NMPG
- Internal Medicine Physician
- Chicago, IL
- NPI 1538111299
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Danbury, CT
- NPI 1548293343
-
dba Ridgefield Visiting Nurse Association
- Home Health Agency
- Ridgefield, CT
- NPI 1497758874
-
- Home Health Agency
- Danbury, CT
- NPI 1083677132
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149552000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597190400000",
"number": "1093754590",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1913 W NORTH AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606221316"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 FEDERAL RD",
"city": "BROOKFIELD",
"state": "CT",
"postal_code": "068042037",
"telephone_number": "203-775-6365",
"fax_number": "203-740-3010"
}
],
"practiceLocations": [
{
"address_1": "75 Remittance Dr",
"address_2": "Suite 1293",
"address_purpose": "LOCATION",
"city": "Chicago",
"state": "IL",
"postal_code": "606751293",
"country_code": "US",
"telephone_number": "312-926-3642",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "CONNELLY",
"first_name": "ROBERT",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-06",
"last_updated": "2020-08-12",
"certification_date": "2020-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IL",
"license": "036-109804",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CT",
"license": "65250",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036-109804",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2020; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.