Active NPI
Michael Jospeh Ackley, DPM
- Primary Podiatric Medicine Podiatrist
- Cheshire, CT
National Provider Identifier
1114928074
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Primary Podiatric Medicine Podiatrist
- License
- 395
- Practice address
- 714 S Main St
Cheshire, CT 06410-3448 - Phone
- (203) 271-0556
- Fax
- (203) 250-9951
- NPI assigned
- Aug 2, 2005
- Reactivated
- Apr 13, 2006
- Last updated
- Nov 14, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 395 | CT | |
| Primary Podiatric Medicine Podiatrist | 213EP1101X | 395 | CT | Primary |
| Sports Medicine Podiatrist | 213ES0000X | 395 | CT | |
| Foot Surgery Podiatrist | 213ES0131X | 395 | CT |
Addresses
Primary practice location
714 S Main St
Cheshire, CT 06410-3448
Mailing address
714 S Main St
Cheshire, CT 06410-3448
Phone (203) 271-0556
Other identifiers 10
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4068714 | Medicaid | CT | |
| 030000395CT01 | Other | CT | ANTHEM BCBS |
| 480028957 | Other | CT | MEDICARE RAILROAD |
| 0542290 | Other | CT | CIGNA |
| 2V1300 | Other | CT | HEALTHNET |
| 2721297 | Other | CT | AETNA |
| NHS221 | Other | CT | OXFORD HEALTH PLAN |
| 129286 | Other | CT | WELLCARE |
| 129286 | Other | CT | FIRST CHOICE PREF ONE |
| 787023 | Other | CT | CONNECTICARE |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 395 | CT | MD | Social Worker |
| 000395 | CT | MD | Naturopath |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1122940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321228800000",
"number": "1114928074",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "714 S MAIN ST",
"city": "CHESHIRE",
"state": "CT",
"postal_code": "064103448",
"telephone_number": "203-271-0556",
"fax_number": "203-250-9951"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "714 S MAIN ST",
"city": "CHESHIRE",
"state": "CT",
"postal_code": "064103448",
"telephone_number": "203-271-0556",
"fax_number": "203-250-9951"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ACKLEY",
"first_name": "MICHAEL",
"middle_name": "JOSPEH",
"name_prefix": "Dr.",
"credential": "DPM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-08-02",
"last_updated": "2011-11-14",
"deactivation_date": "2006-03-21",
"reactivation_date": "2006-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "CT",
"license": "395",
"primary": false
},
{
"code": "213EP1101X",
"taxonomy_group": "",
"desc": "Podiatrist, Primary Podiatric Medicine",
"state": "CT",
"license": "395",
"primary": true
},
{
"code": "213ES0000X",
"taxonomy_group": "",
"desc": "Podiatrist, Sports Medicine",
"state": "CT",
"license": "395",
"primary": false
},
{
"code": "213ES0131X",
"taxonomy_group": "",
"desc": "Podiatrist, Foot Surgery",
"state": "CT",
"license": "395",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4068714",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBS",
"identifier": "030000395CT01",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "480028957",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "0542290",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHNET",
"identifier": "2V1300",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "2721297",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD HEALTH PLAN",
"identifier": "NHS221",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLCARE",
"identifier": "129286",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST CHOICE PREF ONE",
"identifier": "129286",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CONNECTICARE",
"identifier": "787023",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cheshire, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.