NPIMap

Organization Active NPI

New Era Rehabilitation Center, Inc

  • Methadone Clinic
  • Bridgeport, CT
National Provider Identifier
1255372108
Registry record updated May 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
License
0266 Issued in CT
Legal business name
NEW ERA REHABILITATION CENTER, INC
Practice address
4675 Main Street
Bridgeport, CT 06606-2864
Phone
(203) 344-0025
Fax
(203) 374-7515
NPI assigned
Jun 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2021

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

Authorized official

Name
Mr. Ebenezer Adekunle Kolade, MDNPI 1376618611
Title
Executive Director
Phone
(203) 562-2101

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Neuromusculoskeletal Medicine & OMM PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 204D00000X 042947 CT
Addiction Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0401X 042947 CT
Addiction Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RA0401X 040029 CT
Adult Mental Health Clinic/Center 261QM0850X
Methadone Clinic 261QM2800X 0266 CT Primary
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X 0266 CT
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 0266 CT

Addresses

Primary practice location

4675 Main Street
Bridgeport, CT 06606-2864

Mailing address

4675 Main Street
Bridgeport, CT 06606-2864
Phone (203) 344-0025

Other identifiers 1

IdentifierTypeStateIssuer
4224507MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT2 enrollments
Opioid treatment program
Medicare-enrolled since Jul 6, 2021

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20051006000655 CT Part B Supplier - Clinic/Group Practice 3072538263 Receives reassigned benefits from 2 practitioners
1 other NPI on this enrollment
Practice locations: Bridgeport, CT; New Haven, CT
O20211103000532 CT Part B Supplier - Opioid Treatment Program (Otp) 3072538263 1 other NPI on this enrollment
Practice locations: New Haven, CT; Bridgeport, CT

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
07D2224216New Era Rehabilitation Center, Inc4675 Main St, Bridgeport, CT 06606Certificate of waiverMay 11, 2027

National Provider Directory

National Provider Directory
Tax ID family
New Era Rehabilitation Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

3851 Main St
Fl 2
Bridgeport, CT 06606
Phone (203) 372-3333

Practitioners & affiliated clinicians

Practitioners 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620777600000",
    "number": "1255372108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4675 MAIN STREET",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066062864",
            "telephone_number": "203-344-0025",
            "fax_number": "203-374-7515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4675 MAIN STREET",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066062864",
            "telephone_number": "203-344-0025",
            "fax_number": "203-374-7515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW ERA REHABILITATION CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-10",
        "last_updated": "2021-05-12",
        "certification_date": "2021-05-12",
        "status": "A",
        "authorized_official_last_name": "KOLADE",
        "authorized_official_first_name": "EBENEZER",
        "authorized_official_middle_name": "ADEKUNLE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "203-562-2101",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "204D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "CT",
            "license": "042947",
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "CT",
            "license": "042947",
            "primary": false
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "CT",
            "license": "040029",
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "CT",
            "license": "0266",
            "primary": true
        },
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": "CT",
            "license": "0266",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "CT",
            "license": "0266",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4224507",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeport, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.