Active NPI
Edward William Coss Jr., M.D.
- Psychiatry Physician
- Waterford, CT
National Provider Identifier
1275665564
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 19584
- Practice address
- 196 Parkway S
Suite 201
Waterford, CT 06385-1234 - Phone
- (860) 443-1111
- Fax
- (860) 443-7090
- NPI assigned
- Mar 12, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 19584 | CT | Primary |
Addresses
Primary practice location
196 Parkway S
Suite 201
Waterford, CT 06385-1234
Mailing address
196 Parkway S
Suite 201
Waterford, CT 06385-1234
Phone (860) 443-1111
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 163373 | Other | CT | MHN |
| 0V8993 | Other | CT | HEALTHNET |
| 111210 | Other | CT | ANTHEM |
| 001195841 | Medicaid | CT | |
| 010019584CT01 | Other | CT | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19584 | CT | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173657600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1327881600000",
"number": "1275665564",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "196 PARKWAY S",
"address_2": "SUITE 201",
"city": "WATERFORD",
"state": "CT",
"postal_code": "063851234",
"telephone_number": "860-443-1111",
"fax_number": "860-443-7090"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "196 PARKWAY S",
"address_2": "SUITE 201",
"city": "WATERFORD",
"state": "CT",
"postal_code": "063851234",
"telephone_number": "860-443-1111",
"fax_number": "860-443-7090"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COSS",
"first_name": "EDWARD",
"middle_name": "WILLIAM",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-12",
"last_updated": "2012-01-30",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CT",
"license": "19584",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MHN",
"identifier": "163373",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHNET",
"identifier": "0V8993",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "111210",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001195841",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "010019584CT01",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2012; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.