Organization Active NPI

Connecticut Medical Associates

  • Internal Medicine Physician
  • Stratford, CT
National Provider Identifier
1114021466
Registry record updated Sep 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CONNECTICUT MEDICAL ASSOCIATES
Practice address
1825 Barnum Ave
Suite 203
Stratford, CT 06614
Phone
(203) 377-5493
Fax
(203) 380-0874
NPI assigned
Sep 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2008

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

Authorized official

Name
Mrs. Denise Marie Allen
Title
Office Manager
Phone
(203) 377-5943

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

1825 Barnum Ave
Suite 203
Stratford, CT 06614

Mailing address

1825 Barnum Ave
Stratford, CT 06614-5333
Phone (203) 377-5493

Other identifiers 1

IdentifierTypeStateIssuer
004395621MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081113000035 CT Part B Supplier - Clinic/Group Practice 3971662453 Receives reassigned benefits from 1 practitioner
Practice locations: Stratford, CT

National Provider Directory

National Provider Directory

Locations

1825 Barnum Ave
Ste 205
Stratford, CT 06614
Phone (203) 377-5493

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222732800000",
    "number": "1114021466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1825 BARNUM AVE",
            "city": "STRATFORD",
            "state": "CT",
            "postal_code": "066145333",
            "telephone_number": "203-377-5493",
            "fax_number": "203-380-0874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1825 BARNUM AVE",
            "address_2": "SUITE 203",
            "city": "STRATFORD",
            "state": "CT",
            "postal_code": "06614",
            "telephone_number": "203-377-5493",
            "fax_number": "203-380-0874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNECTICUT MEDICAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-08",
        "last_updated": "2008-09-30",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "DENISE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "203-377-5943",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004395621",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stratford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.