NPIMap

Organization Active NPI

Physician Services of Northeast Connecticut, LLC

  • Family Medicine Physician
  • Putnam, CT
National Provider Identifier
1194966556
Registry record updated Mar 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PHYSICIAN SERVICES OF NORTHEAST CONNECTICUT, LLC
Doing business as
Pomfret Street Family Medicine
Practice address
235 Pomfret St
Putnam, CT 06260-1835
Phone
(860) 928-0493
Fax
(860) 928-9255
NPI assigned
Mar 16, 2009
Organization subpart
Yes
Parent organization
DAY KIMBALL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 16, 2009

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

Authorized official

Name
Robert E Smanik
Title
Ceo
Phone
(860) 928-6541

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

235 Pomfret St
Putnam, CT 06260-1835

Mailing address

PO Box 8469
Belfast, ME 04915-8469
Phone (860) 928-6541

Other identifiers 1

IdentifierTypeStateIssuer
1891962221MedicaidCT

Other names 1

  • Pomfret Street Family Medicine Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Physician Services of Northeast6 organizations share this tax ID, including this one
Part of
Day Kimball Healthcare Inc

Other organizations with this tax ID 5

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1237161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237161600000",
    "number": "1194966556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8469",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049158469",
            "telephone_number": "860-928-6541",
            "fax_number": "860-963-6450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 POMFRET ST",
            "city": "PUTNAM",
            "state": "CT",
            "postal_code": "062601835",
            "telephone_number": "860-928-0493",
            "fax_number": "860-928-9255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIAN SERVICES OF NORTHEAST CONNECTICUT, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DAY KIMBALL HOSPITAL",
        "enumeration_date": "2009-03-16",
        "last_updated": "2009-03-16",
        "status": "A",
        "authorized_official_last_name": "SMANIK",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "860-928-6541"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1891962221",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pomfret Street Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Putnam, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2009; 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.