NPIMap

Individual provider Active NPI

John Joseph Hennessey, M.D.

  • Internal Medicine Physician
  • Gales Ferry, CT
National Provider Identifier
1215916564
Registry record updated Nov 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
037592 Issued in CT
Practice address
1527 Route 12
Suite 1
Gales Ferry, CT 06335-1800
Phone
(860) 464-7253
Fax
(860) 464-7404
NPI assigned
Jan 14, 2006
Last updated
Nov 30, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 037592 CT Primary

Addresses

Primary practice location

1527 Route 12
Suite 1
Gales Ferry, CT 06335-1800

Mailing address

PO Box 355
Gales Ferry, CT 06335-0355
Phone (860) 464-7253

Other identifiers 1

IdentifierTypeStateIssuer
001375923MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100902000771 CT Practitioner - Internal Medicine 0143362525 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Tufts University School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gales Ferry Medical Group LLCGroup PAC ID 3971645359, 4 clinicians
Ptsma IncGroup PAC ID 7911800180, shared by 11 NPIs, 173 clinicians

Practice addresses (Care Compare)

1527 Route 12
Gales Ferry, CT 06335-1800
Phone (860) 464-7274

37 S Broad St
Unit 12
Pawcatuck, CT 06379-7909
Phone (860) 495-1919

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Gales Ferry Medical Group LLC Internal Medicine CurrentSince Sep 1, 1999 Accepting new patients

Locations

1527 Route 12
Gales Ferry, CT 06335
Phone (860) 464-7248

1527 Route 12
Ste 101
Gales Ferry, CT 06335
Phone (860) 464-7274

Interoperability endpoints

  • Direct secure messaging: john.hennessey.1@27673.direct.athenahealth.com

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Avalon Health Care Center at StoneridgeMystic, CT, CCN 075437 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 May 1, 2024
Feb 17, 2025
Pendleton Rehabilitation and Nursing CenterMystic, CT, CCN 075341 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Sep 1, 2022
Sep 1, 2022

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1137196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354233600000",
    "number": "1215916564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 355",
            "city": "GALES FERRY",
            "state": "CT",
            "postal_code": "063350355",
            "telephone_number": "860-464-7253",
            "fax_number": "860-464-7404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1527 ROUTE 12",
            "address_2": "SUITE 1",
            "city": "GALES FERRY",
            "state": "CT",
            "postal_code": "063351800",
            "telephone_number": "860-464-7253",
            "fax_number": "860-464-7404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENNESSEY",
        "first_name": "JOHN",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-14",
        "last_updated": "2012-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "037592",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001375923",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gales Ferry, CT

Sources for this page

Verify at the official NPI Registry.