Individual provider Active NPI

Regina K Stuart, MD

  • Surgery Physician
  • Willimantic, CT
National Provider Identifier
1114907029
Registry record updated Oct 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
57003 Issued in CT
Practice address
5 Founders St Ste 102
Willimantic, CT 06226-2050
Phone
(609) 456-2898
Fax
(609) 456-3078
NPI assigned
Jan 18, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 57003 CT Primary
Surgery Physician 208600000X 01061211A IN

Addresses

Primary practice location

5 Founders St Ste 102
Willimantic, CT 06226-2050

Mailing address

2518 E Dupont Rd
Fort Wayne, IN 46825-1675
Phone (260) 432-4400

Other identifiers 1

IdentifierTypeStateIssuer
200503510MedicaidIN

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171106000903 CT Practitioner - General Surgery 0547203705 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
57003CTMDSurgery Physician
01061211AINMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Signify Health Medical Associates, PLLC CurrentSince Jul 30, 2023 Accepting new patients
Hartford Healthcare Medical Group Specialists LLC CurrentSince Jun 1, 2019 Accepting new patients
Hartford Healthcare Medical Group, Inc Surgery CurrentSince Oct 1, 2017 Accepting new patients
Hartford Healthcare Medical Group Specialists, PLLC Surgery CurrentSince Jun 1, 2019 Accepting new patients
Tallgrass Balance, Hearing & Physical Therapy LLC PastSince Oct 1, 2012 Accepting new patients
Tallgrass General, Vascular & Thoracic Surgery Past Accepting new patients

Locations

175 Capital Blvd
Fl 4
Rocky Hill, CT 06067
Phone (860) 380-0452

55 Meriden Ave
Ste 1D
Southington, CT 06489
Phone (860) 276-5144

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

1290 Silas Deane Hwy
Wethersfield, CT 06109
Phone (860) 972-6977

5 Founders St
Ste 102
Willimantic, CT 06226
Phone (860) 423-5000

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1137542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1507593600000",
    "number": "1114907029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2518 E DUPONT RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251675",
            "telephone_number": "260-432-4400",
            "fax_number": "260-969-6833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 FOUNDERS ST STE 102",
            "city": "WILLIMANTIC",
            "state": "CT",
            "postal_code": "062262050",
            "telephone_number": "609-456-2898",
            "fax_number": "609-456-3078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STUART",
        "first_name": "REGINA",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-18",
        "last_updated": "2017-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CT",
            "license": "57003",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IN",
            "license": "01061211A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200503510",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Willimantic, CT

Sources for this page

Verify at the official NPI Registry.