Laura Celeste Black, M.D.
Individual provider Active NPI Internal Medicine Physician · West Hartford, CT
NPI 1124388129 · NPPES record last updated May 15, 2018
Key facts
- NPI
- 1124388129
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- MD14897 (RI)
- Practice address
- 336 N Main St
West Hartford, CT 06117 - Phone
- (860) 232-4891
- Fax
- (860) 236-1016
- NPI assigned
- May 23, 2012
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- University of Vermont College of Medicine, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Hartford Healthcare Medical Group Inc
Practice addresses (Care Compare)
336 N Main St
West Hartford, CT 06117-2675
Phone (860) 232-4891
Hospital & facility affiliations
- Hartford Healthcare at Home
- Hartford Hospital
- The Hospital of Central Connecticut
- Umass Memorial Health - Harrington Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 94.48 of 100
- Quality
- 83.4
- Promoting interoperability
- 100
- Improvement activities
- 40
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 |
|---|---|---|---|---|
| I20180530000503 | CT | Practitioner - Internal Medicine | 2062639743 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hartford Healthcare Medical Group, Inc | Internal Medicine | Current |
Accepting new patients |
| Hartford Healthcare Medical Group, Inc | Past | Accepting new patients |
Locations
55 Meriden Ave
Ste 1D
Southington, CT 06489
Phone (860) 276-5144
336 N Main St
West Hartford, CT 06117
Phone (860) 200-7701
1290 Silas Deane Hwy
Wethersfield, CT 06109
Phone (860) 972-6977
Interoperability endpoints
- laura.black@xdr.hhchealthdirect.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD14897 | RI | Yes |
Addresses
Primary practice location
336 N Main St
West Hartford, CT 06117
Mailing address
17 Virginia Ave
Suite 107
Providence, RI 02905-4406
Phone (401) 443-4992
Other names
- Laura Celeste Depouli
Other providers in West Hartford, CT
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- Patricia Black
- Donna Marie Blain
- Charles Lee Blair
- Shannon Blake
- Charvel Lee Renee Blanco
All providers in West Hartford, CT · Internal 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 May 15, 2018. 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.