Desmond Walter Ebanks, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

34291 Issued in CT

Practice address

639 Park Rd
2ND Floor
West Hartford, CT 06107-3443

Phone

(860) 748-4064

Fax

(860) 838-2507

NPI assigned

Sep 4, 2008

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jan 25, 2018 through Jan 25, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1220486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1220486400000",
    "number": "1275781122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 ALBANY TPKE",
            "address_2": "SUITE 164",
            "city": "CANTON",
            "state": "CT",
            "postal_code": "060192520",
            "telephone_number": "860-748-4064",
            "fax_number": "860-838-2507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "639 PARK RD",
            "address_2": "2ND FLOOR",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061073443",
            "telephone_number": "860-748-4064",
            "fax_number": "860-838-2507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBANKS",
        "first_name": "DESMOND",
        "middle_name": "WALTER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-09-04",
        "last_updated": "2008-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "34291",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in West Hartford, CT
• Providers in West Hartford, CT by specialty
• Internal Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2008; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.