NPIMap

Individual provider Active NPI

Mark David Deponte, MD

  • Family Medicine Physician
  • Lisbon, CT
National Provider Identifier
1265434583
Registry record updated Nov 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
039945 Issued in CT
Practice address
2 Lee Rd
Lisbon, CT 06351
Phone
(860) 376-4451
Fax
(860) 376-5977
NPI assigned
Jun 1, 2005
Last updated
Nov 19, 2009By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 19, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 039945 CT Primary

Addresses

Primary practice location

2 Lee Rd
Lisbon, CT 06351

Mailing address

2 Lee Rd
Lisbon, CT 06351
Phone (860) 376-4451

Other identifiers 5

IdentifierTypeStateIssuer
020323907OtherUNHC
001399452MedicaidCT
010039945CT01OtherBCBS
020323907OtherCIGNA
2V1508OtherHEALTHNET

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
I20100203000351 CT Practitioner - General PracticePractitioner - Family Practice 9335282029 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mark D. Deponte, M.D.,LLCGroup PAC ID 8325181019, 3 clinicians

Practice addresses (Care Compare)

2 Lee Rd
Lisbon, CT 06351-3015
Phone (860) 376-4451

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mark D. Deponte, M.D.,LLC Family Medicine CurrentSince Dec 11, 2009 Accepting new patients
Bert Coppotelli MD LLC Family Medicine CurrentSince Jan 15, 2010 Accepting new patients

Organizations & group practices 2

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 7

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": "1117584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258588800000",
    "number": "1265434583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 LEE RD",
            "city": "LISBON",
            "state": "CT",
            "postal_code": "06351",
            "telephone_number": "860-376-4451",
            "fax_number": "860-376-5977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 LEE RD",
            "city": "LISBON",
            "state": "CT",
            "postal_code": "06351",
            "telephone_number": "860-376-4451",
            "fax_number": "860-376-5977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEPONTE",
        "first_name": "MARK",
        "middle_name": "DAVID",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-01",
        "last_updated": "2009-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CT",
            "license": "039945",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNHC",
            "identifier": "020323907",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001399452",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "010039945CT01",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "020323907",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "2V1508",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lisbon, CT

Sources for this page

Verify at the official NPI Registry.