Active NPI
Michael T Kovalchik, M.D.
- Nephrology Physician
- Torrington, CT
National Provider Identifier
1124003892
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- 020094
- Practice address
- 780 Litchfield St
Suite200
Torrington, CT 06790-6268 - Phone
- (860) 489-1984
- Fax
- (860) 496-2195
- NPI assigned
- Dec 14, 2005
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | 020094 | CT | Primary |
Addresses
Primary practice location
780 Litchfield St
Suite200
Torrington, CT 06790-6268
Mailing address
780 Litchfield St
Suite200
Torrington, CT 06790-6268
Phone (860) 489-1984
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 010020094CT01 | Other | ANTHEM | |
| 539143 | Other | AETNA | |
| P3600333 | Other | OXFORD | |
| 00120094800 | Other | ANTHEM FAMILY | |
| 1200948 | Medicaid | CT | |
| 752466 | Other | CONNECTICARE | |
| 040477 | Other | HEALTH NET |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 020094 | CT | MD | Nephrology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134518400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1259798400000",
"number": "1124003892",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "780 LITCHFIELD ST",
"address_2": "SUITE200",
"city": "TORRINGTON",
"state": "CT",
"postal_code": "067906268",
"telephone_number": "860-489-1984",
"fax_number": "860-496-2195"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "780 LITCHFIELD ST",
"address_2": "SUITE200",
"city": "TORRINGTON",
"state": "CT",
"postal_code": "067906268",
"telephone_number": "860-489-1984",
"fax_number": "860-496-2195"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOVALCHIK",
"first_name": "MICHAEL",
"middle_name": "T",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-12-14",
"last_updated": "2009-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "CT",
"license": "020094",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "010020094CT01",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "539143",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD",
"identifier": "P3600333",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM FAMILY",
"identifier": "00120094800",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1200948",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CONNECTICARE",
"identifier": "752466",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH NET",
"identifier": "040477",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Torrington, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.