NPIMap

Organization Active NPI

Midstate Medical Center

  • General Acute Care Hospital
  • Meriden, CT
National Provider Identifier
1154425288
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
0070 Issued in CT
Legal business name
MIDSTATE MEDICAL CENTER
Practice address
435 Lewis Ave
Meriden, CT 06451-2101
Phone
(860) 696-6287
Fax
(860) 696-6035
NPI assigned
Sep 11, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Ralph W Becker
Title
VP Finance
Phone
(860) 696-6220

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 0070 CT Primary

Addresses

Primary practice location

435 Lewis Ave
Meriden, CT 06451-2101

Mailing address

435 Lewis Ave
Meriden, CT 06451-2101
Phone (860) 696-6287

Other names 1

  • Midstate Hospitalist Program Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040203000244 CT Part B Supplier - Clinic/Group Practice 7416840699 Receives reassigned benefits from 636 practitioners
3 other NPIs on this enrollment
Practice locations: Meriden, CT; West Hartford, CT; Wallingford, CT

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1290 Silas Deane Hwy
Fl 1
Wethersfield, CT 06109
Phone (860) 972-6970

Practitioners & affiliated clinicians

Practitioners 662

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 662

NPI Registry JSON

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

{
    "created_epoch": "1157932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1154425288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "435 LEWIS AVE",
            "city": "MERIDEN",
            "state": "CT",
            "postal_code": "064512101",
            "telephone_number": "860-696-6287",
            "fax_number": "860-696-6035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 LEWIS AVE",
            "city": "MERIDEN",
            "state": "CT",
            "postal_code": "064512101",
            "telephone_number": "860-696-6287",
            "fax_number": "860-696-6035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDSTATE MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BECKER",
        "authorized_official_first_name": "RALPH",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "VP  FINANCE",
        "authorized_official_telephone_number": "860-696-6220",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "CT",
            "license": "0070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Midstate Hospitalist Program",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Meriden, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.