NPIMap

Organization Active NPI

Danbury Medical Group LLC

  • Internal Medicine Physician
  • Danbury, CT
National Provider Identifier
1114047024
Registry record updated Oct 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
3360762 Issued in CT
Legal business name
DANBURY MEDICAL GROUP LLC
Practice address
100 Reserve Rd Ste A4
Danbury, CT 06810-5267
Phone
(203) 794-1979
Fax
(203) 794-1796
NPI assigned
Apr 2, 2007
Last updated
Oct 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2022

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

Authorized official

Name
Dr. Martin H Williams, MDNPI 1902863798
Title
Owner
Phone
(203) 794-1979

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 3360762 CT Primary
Gastroenterology Physician 207RG0100X NU
Podiatrist 213E00000X NU

Addresses

Primary practice location

100 Reserve Rd Ste A4
Danbury, CT 06810-5267

Mailing address

100 Reserve Rd Ste A4
Danbury, CT 06810-5267
Phone (203) 794-1979

Other identifiers 1

IdentifierTypeStateIssuer
004108115MedicaidCT

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
07D0100927Danbury Medical Group LLC100 Reserve Rd, Ste 4a, Danbury, CT 06810Certificate of waiverSep 30, 2026

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666310400000",
    "number": "1114047024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 RESERVE RD STE A4",
            "city": "DANBURY",
            "state": "CT",
            "postal_code": "068105267",
            "telephone_number": "203-794-1979",
            "fax_number": "203-794-1796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 RESERVE RD STE A4",
            "city": "DANBURY",
            "state": "CT",
            "postal_code": "068105267",
            "telephone_number": "203-794-1979",
            "fax_number": "203-794-1796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DANBURY MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2022-10-21",
        "certification_date": "2022-10-21",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-794-1979",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "3360762",
            "primary": true
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004108115",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Danbury, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.

Verify at the official NPI Registry.