NPIMap

Organization Active NPI

Manchester Memorial Hospital

  • Psychiatric Hospital Unit
  • Manchester, CT
National Provider Identifier
1154364016
Registry record updated Jan 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
License
0048 Issued in CT
Legal business name
MANCHESTER MEMORIAL HOSPITAL
Practice address
320 Main St
Manchester, CT 06040-4144
Phone
(860) 646-1222
NPI assigned
Jun 14, 2006
Organization subpart
Yes
Parent organization
MANCHESTER MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 26, 2015

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

Authorized official

Name
Peter Karl
Title
Ceo
Phone
(860) 646-1222

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X 0048 CT
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X 0048 CT
Addiction Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0802X 0048 CT
Child & Adolescent Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0804X 0048 CT
Geriatric Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0805X 0048 CT
Psychiatric Hospital Unit 273R00000X 0048 CT Primary
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

320 Main St
Manchester, CT 06040-4144

Mailing address

71 Haynes St
Manchester, CT 06040-4131
Phone (860) 646-1222

Other identifiers 1

IdentifierTypeStateIssuer
7228711MedicaidCT

Other names 1

  • Manchester Memoril Hospital Psychiatric Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Prospect Manchester Hospital Inc3 organizations share this tax ID, including this one
Part of
Meanchester Mem Hosp-ER

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 4

Organizations listed as members of this organization in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422230400000",
    "number": "1154364016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "71 HAYNES ST",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060404131",
            "telephone_number": "860-646-1222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 MAIN ST",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060404144",
            "telephone_number": "860-646-1222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANCHESTER MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MANCHESTER MEMORIAL HOSPITAL",
        "enumeration_date": "2006-06-14",
        "last_updated": "2015-01-26",
        "status": "A",
        "authorized_official_last_name": "KARL",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "860-646-1222"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "0048",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CT",
            "license": "0048",
            "primary": false
        },
        {
            "code": "2084P0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": "CT",
            "license": "0048",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "CT",
            "license": "0048",
            "primary": false
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "CT",
            "license": "0048",
            "primary": false
        },
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "CT",
            "license": "0048",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7228711",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Manchester Memoril Hospital Psychiatric",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Manchester, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.