NPIMap

Individual provider Active NPI

Kevin Russell Dougherty, M.D.

  • Cardiovascular Disease Physician
  • Hartford, CT
National Provider Identifier
1114188711
Registry record updated May 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
52940 Issued in CT
Practice address
85 Seymour St
Suite 719
Hartford, CT 06106-5501
Phone
(860) 522-0604
Fax
(860) 522-1761
NPI assigned
Jun 17, 2008
Last updated
May 20, 2015By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 20, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 247283 MA
Cardiovascular Disease Physician 207RC0000X 52940 CT Primary

Addresses

Primary practice location

85 Seymour St
Suite 719
Hartford, CT 06106-5501

Mailing address

305 Western Blvd
Suite 100
Glastonbury, CT 06033-4380
Phone (860) 522-0604

Other identifiers 1

IdentifierTypeStateIssuer
C00585OtherCTMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140813001262 CT Practitioner - Cardiovascular Disease (Cardiology) 4486871530 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Tufts University School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hartford Healthcare Medical Group Specialists PLLCGroup PAC ID 3173866241, 1,555 clinicians
Consulting Cardiologists PCGroup PAC ID 7113916149, 23 clinicians
Midstate Medical CenterGroup PAC ID 7416840699, 187 clinicians
Hartford HospitalGroup PAC ID 2567366016, 1,040 clinicians

Practice addresses (Care Compare)

10 Birdseye Rd
Suite 102
Farmington, CT 06032-2489
Phone (860) 678-5700

100 Simsbury Rd
Suite 202
Avon, CT 06001-3793
Phone (860) 522-0604

1062 Barnes Rd
Suite 300
Wallingford, CT 06492-2576
Phone (203) 265-9831

305 Western Blvd
Suite 100
Glastonbury, CT 06033-4380
Phone (860) 522-0604

330 Washington St
Suite 220
Norwich, CT 06360-2700
Phone (203) 265-9831

435 Lewis Ave
Meriden, CT 06451-2101
Phone (203) 694-8200

80 Seymour St
Hartford, CT 06102-8000
Phone (860) 545-7500

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.42 of 100Reported as group
Quality
83.36
Promoting interoperability
100
Improvement activities
40
Cost
75.9

Merit-based Incentive Payment System (MIPS)

Final score
92.45 of 100Reported as individual
Quality
83.74
Promoting interoperability
100
Improvement activities
40
Cost
80.87

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
247283MAMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hartford Healthcare Medical Group Specialists, PLLC Cardiovascular Disease CurrentSince Dec 7, 2021 Accepting new patients
Consulting Cardiologists, P.C. Cardiovascular Disease CurrentSince Jul 14, 2014 Accepting new patients
Midstate Medical Center Current Accepting new patients
Hartford Healthcare Medical Group Specialists LLC CurrentSince Dec 7, 2021 Accepting new patients
Midstate Medical Center CurrentSince Apr 1, 2025 Accepting new patients
Hartford Hospital CurrentSince Apr 1, 2025 Accepting new patients
Midstate Medical Center CurrentSince Apr 1, 2025 Accepting new patients
Connecticut Heart Physicians, Inc. Cardiovascular Disease CurrentSince Jul 14, 2014 Accepting new patients
Hartford Hospital CurrentSince Apr 1, 2025 Accepting new patients

Locations

10 Birdseye Rd
Ste 100
Farmington, CT 06032
Phone (860) 678-2683

10 Birdseye Rd
Ste 102
Farmington, CT 06032
Phone (860) 678-5700

305 Western Blvd
Ste 100
Glastonbury, CT 06033
Phone (860) 525-1532

85 Seymour St
Ste 719
Hartford, CT 06106
Phone (860) 249-9175

435 Lewis Ave
Meriden, CT 06451
Phone (203) 284-1340

1244 Storrs Rd
Storrs Mansfield, CT 06268
Phone (860) 724-2579

1025 Silas Deane Hwy
Wethersfield, CT 06109
Phone (860) 696-2296

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/6291/brand/1/csg/1/fhir/r4
  • Direct secure messaging: kevin.dougherty.1@6291.direct.athenahealth.com

Organizations & group practices 9

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.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1213660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1432080000000",
    "number": "1114188711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 WESTERN BLVD",
            "address_2": "SUITE 100",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060334380",
            "telephone_number": "860-522-0604",
            "fax_number": "860-522-1761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 SEYMOUR ST",
            "address_2": "SUITE 719",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061065501",
            "telephone_number": "860-522-0604",
            "fax_number": "860-522-1761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGHERTY",
        "first_name": "KEVIN",
        "middle_name": "RUSSELL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-17",
        "last_updated": "2015-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MA",
            "license": "247283",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CT",
            "license": "52940",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "C00585",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hartford, CT

Sources for this page

Verify at the official NPI Registry.