Kenneth R, Graham II, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

046639 Issued in CT

Practice address

1351 Washington Blvd
Stamford, CT 06902-2419

Phone

(203) 621-3764

Fax

(203) 621-3701

NPI assigned

Dec 28, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

George Washington University School of Medicine, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Optimus Health Care IncGroup PAC ID 9335051580, 79 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Stamford Hospital Hospital, Stamford, CT, CCN 070006
• Greenwich Hospital Association - Hospital, Greenwich, CT, CCN 070018

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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

• Optimus Health Care Inc

  • Federally Qualified Health Center (FQHC)
  • Bridgeport, CT
  • NPI 1669445946
  Medicare reassignment Care Compare group NPD
• Westchester Jewish Community Services Inc.

  • Community/Behavioral Health Agency
  • White Plains, NY
  • NPI 1457381196
  NPD (past)

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

• Greenwich Hospital

  • General Acute Care Hospital
  • Greenwich, CT
  • NPI 1609846088
  Care Compare affiliation
• Stamford Hospital

  • General Acute Care Hospital
  • Stamford, CT
  • NPI 1356331425
  Care Compare affiliation

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453680000000",
    "number": "1245396266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1351 WASHINGTON BLVD",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069022419",
            "telephone_number": "203-621-3764",
            "fax_number": "203-621-3701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1351 WASHINGTON BLVD",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069022419",
            "telephone_number": "203-621-3764",
            "fax_number": "203-621-3701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "KENNETH",
        "middle_name": "R,",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-28",
        "last_updated": "2016-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CT",
            "license": "046639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Debra K Gotz, MD
• Pratima Goyal, M.D.
• Joseph Grabicki, D.P.T.
• Grade a Market Inc
• Grade a Shop Rite Commerce Rd LLC
• Lori Graham, O.T.
• Shuli Graham
• Debra Susan Gramlich, M.D.
• Kristen Granieri
• Jordanne Grant

• Psychiatry Physician in Stamford, CT
• Providers in Stamford, CT by specialty
• Psychiatry Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.