NPIMap

Organization Active NPI

Hartford Healthcare Medical Group, Inc

  • Durable Medical Equipment & Medical Supplies
  • Enfield, CT
National Provider Identifier
1164768255
Registry record updated Jul 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
HARTFORD HEALTHCARE MEDICAL GROUP, INC
Practice address
100 Hazard Ave
Ste. 206
Enfield, CT 06082-5446
Phone
(860) 749-6252
NPI assigned
Dec 18, 2012
Last updated
Jul 17, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2019

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

Authorized official

Name
Mark Bancroft Vye
Title
VP Administration
Phone
(860) 972-7858

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU Primary
Customized Equipment (DME) 332BC3200X NU
Urology Physician 208800000X NU
Podiatrist 213E00000X NU
Foot & Ankle Surgery Podiatrist 213ES0103X NU

Addresses

Primary practice location

100 Hazard Ave
Ste. 206
Enfield, CT 06082-5446

Mailing address

1290 Silas Deane Hwy
Wethersfield, CT 06109-4337
Phone (860) 972-7040

National Provider Directory

National Provider Directory
Tax ID family
Hartford Healthcare Medical Group Specialists LLC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

100 Hazard Ave
Ste 206
Enfield, CT 06082
Phone (860) 749-1985

NPI Registry JSON

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

{
    "created_epoch": "1355788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563321600000",
    "number": "1164768255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1290 SILAS DEANE HWY",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061094337",
            "telephone_number": "860-972-7040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HAZARD AVE",
            "address_2": "STE. 206",
            "city": "ENFIELD",
            "state": "CT",
            "postal_code": "060825446",
            "telephone_number": "860-749-6252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARTFORD HEALTHCARE MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-18",
        "last_updated": "2019-07-17",
        "status": "A",
        "authorized_official_last_name": "VYE",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "BANCROFT",
        "authorized_official_title_or_position": "VP ADMINISTRATION",
        "authorized_official_telephone_number": "860-972-7858"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Enfield, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2019; 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.