Medical Center of Northeast Connecticut

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

MEDICAL CENTER OF NORTHEAST CONNECTICUT

Practice address

612 Hartford Pike
Dayville, CT 06241-2159

Phone

(860) 779-0284

Fax

(860) 779-0386

NPI assigned

Jul 25, 2007

Organization subpart

No

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

Authorized official

Name

Paul J Matty, MD

Title

Medical Director

Phone

(860) 779-0284

Specialties & licenses 1

Addresses

Other identifiers 6

Practitioners 1

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

• William Roy Karl Johnson, MD

  • Internal Medicine Physician
  • Dayville, CT
  • NPI 1710057351
  NPD (past)

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

{
    "created_epoch": "1185321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1220400000000",
    "number": "1194915314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 HARTFORD PIKE",
            "city": "DAYVILLE",
            "state": "CT",
            "postal_code": "062412159",
            "telephone_number": "860-779-0284",
            "fax_number": "860-779-0386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 HARTFORD PIKE",
            "city": "DAYVILLE",
            "state": "CT",
            "postal_code": "062412159",
            "telephone_number": "860-779-0284",
            "fax_number": "860-779-0386"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL CENTER OF NORTHEAST CONNECTICUT",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-25",
        "last_updated": "2008-09-03",
        "status": "A",
        "authorized_official_last_name": "MATTY",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "860-779-0284",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001172865",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001367178",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001292490",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001413476",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001228592",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001295006",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cheryllynn Matos
• Paul Joseph Matty, MD
• Randi Matzenbacher, LMSW
• Rachelle Mauer
• Melissa Lee McKeon, MS, OTR/L
• Vanessa Medina, M. S. W.
• Rebecca Mercado, MFT
• Kerry Lee Methot, LMT
• Alexander P Miano, M.D.
• Gina Michelle Mills, MSW, LCSW

• Internal Medicine Physician in Dayville, CT
• Providers in Dayville, CT by specialty
• Internal Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2008; 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.