Active NPI
Bruce E. Gould, M.D.
- Internal Medicine Physician
- Hartford, CT
National Provider Identifier
1104837541
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 029114
- Practice address
- 131 Coventry St
Burgdorf Clinic - 2ND Floor
Hartford, CT 06112-1548 - Phone
- (860) 714-3690
- Fax
- (860) 714-8683
- NPI assigned
- Aug 11, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 029114 | CT | Primary |
Addresses
Primary practice location
131 Coventry St
Burgdorf Clinic - 2ND Floor
Hartford, CT 06112-1548
Mailing address
131 Coventry St
Burgdorf Clinic - 2ND Floor
Hartford, CT 06112-1548
Phone (860) 714-3690
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001291145CL | Medicaid | CT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 029114 | CT | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280361600000",
"number": "1104837541",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "131 COVENTRY ST",
"address_2": "BURGDORF CLINIC - 2ND FLOOR",
"city": "HARTFORD",
"state": "CT",
"postal_code": "061121548",
"telephone_number": "860-714-3690",
"fax_number": "860-714-8683"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "131 COVENTRY ST",
"address_2": "BURGDORF CLINIC - 2ND FLOOR",
"city": "HARTFORD",
"state": "CT",
"postal_code": "061121548",
"telephone_number": "860-714-3690",
"fax_number": "860-714-8683"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOULD",
"first_name": "BRUCE",
"middle_name": "E.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-11",
"last_updated": "2010-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CT",
"license": "029114",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001291145CL",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hartford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.