Individual provider Active NPI

Lancelot P Morgan, PA

  • Physician Assistant
  • Manchester, CT
National Provider Identifier
1265430219
Registry record updated May 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
001620 Issued in CT
Practice address
360 Tolland Tpke
3C
Manchester, CT 06042-1771
Phone
(860) 643-0063
Fax
(860) 643-3642
NPI assigned
Jul 13, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 001620 CT Primary

Addresses

Primary practice location

360 Tolland Tpke
3C
Manchester, CT 06042-1771

Mailing address

99 E River Dr
5TH Floor
East Hartford, CT 06108-3288
Phone (860) 282-4022

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050628000199 CT Practitioner - Physician Assistant 1355386582 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sports Medicine and Orthopedic Surgery, PCGroup PAC ID 6406759935, 2 clinicians

Practice addresses (Care Compare)

360 Tolland Tpke
Suite 3C
Manchester, CT 06042-1770
Phone (860) 649-0063

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
001620CTMDOptician

Practice roles

OrganizationSpecialtyStatusNew patients
Sports Medicine and Orthopedic Surgery, P.C. CurrentSince May 21, 2012 Accepting new patients

Locations

99 E River Dr
Fl 5
Hartford, CT 06108
Phone (860) 282-4022

360 Tolland Tpke
Ste 3C
Manchester, CT 06042
Phone (860) 643-0063

100 Gerber Dr
Tolland, CT 06084
Phone (860) 896-9145

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1121212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1337558400000",
    "number": "1265430219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 E RIVER DR",
            "address_2": "5TH FLOOR",
            "city": "EAST HARTFORD",
            "state": "CT",
            "postal_code": "061083288",
            "telephone_number": "860-282-4022",
            "fax_number": "860-289-0742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 TOLLAND TPKE",
            "address_2": "3C",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060421771",
            "telephone_number": "860-643-0063",
            "fax_number": "860-643-3642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORGAN",
        "first_name": "LANCELOT",
        "middle_name": "P",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-13",
        "last_updated": "2012-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "001620",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, CT

Sources for this page

Verify at the official NPI Registry.