Israel Cordero, MD
Individual provider Active NPI Family Medicine Physician · Portland, CT
NPI 1124281613 · NPPES record last updated Apr 11, 2017
Key facts
- NPI
- 1124281613
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 051043 (CT)
- Practice address
- 270 Main St
Portland, CT 06480-1859 - Phone
- (860) 342-3392
- Fax
- (860) 358-8658
- NPI assigned
- Jul 7, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University of Connecticut School of Medicine, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- MHS Primary Care, Inc.
Practice addresses (Care Compare)
896 Washington St
Middletown, CT 06457-2912
Phone (860) 788-3632
Hospital & facility affiliations
- Middlesex Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120802000297 | CT | Practitioner - Family Practice | 3577719830 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051043 | CT | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| MHS Primary Care | Family Medicine | Current |
Accepting new patients |
| MHS Primary Care Inc | Family Medicine | Current |
Accepting new patients |
| MHS Primary Care, Inc | Family Medicine | Current | Accepting new patients |
| MHS Primary Care Inc | Family Medicine | Current |
Accepting new patients |
Locations
896 Washington St
Middletown, CT 06457
Phone (860) 788-3632
28 Crescent St
Middletown, CT 06457
Phone (860) 358-6000
270 Main St
Ste A
Portland, CT 06480
Phone (860) 358-5040
270 Main St
Portland, CT 06480
Phone (860) 342-3392
Interoperability endpoints
- icordero15079@middlesexhealthprd.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 051043 | CT | Yes |
Addresses
Primary practice location
270 Main St
Portland, CT 06480-1859
Mailing address
28 Crescent St
Middletown, CT 06457-3654
Phone (860) 358-4820
Other providers in Portland, CT
- Justin Caskey
- Kelsey Ejzak Caulfield
- Carl CHI
- Cna'S Care LLC
- Janet S. Colonghi
- Katie Lynn Craig
- Amy Elizabeth Dean
- Diamond Standard Care
- Diana Abate Schneider, LLC
- Jamie M Dickson
All providers in Portland, CT · Family Medicine Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 11, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.