Mystic Geriatrics, LLC

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

Legal business name

MYSTIC GERIATRICS, LLC

Practice address

3 Heron Rd
Mystic, CT 06355-3253

Phone

(860) 536-5302

Fax

(860) 536-5302

NPI assigned

Jul 18, 2006

Organization subpart

No

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

Authorized official

Name

Ms. June Fliri, M.B.A., M.S.W.

Title

Manager

Phone

(860) 536-8882

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CT, RI2 enrollments

Enrollment records 2

Locations

Practitioners 2

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

• David Holland Burchenal, MD

  • Internal Medicine Physician
  • Stonington, CT
  • NPI 1922050632
  NPD (past)
• Karen S Williams, A.P.R.N.

  • Gerontology Nurse Practitioner
  • Salem, CT
  • NPI 1184648925
  NPD (past)

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437350400000",
    "number": "1336167238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 HERON RD",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "063553253",
            "telephone_number": "860-536-5302",
            "fax_number": "860-536-5302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 HERON RD",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "063553253",
            "telephone_number": "860-536-5302",
            "fax_number": "860-536-5302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYSTIC GERIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-18",
        "last_updated": "2015-07-20",
        "status": "A",
        "authorized_official_last_name": "FLIRI",
        "authorized_official_first_name": "JUNE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "860-536-8882",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "M.B.A., M.S.W."
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Acute Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caitlin Ann Morse, D.P.T.
• James B Moss III, MD
• Christine L. Murray
• Mystic Bridge to Wellness, LLC
• Mystic Dental Group, P.C.
• Mystic Healthcare & Rehabilitation Center LLC
• Mystic Healthcare and Rehabilitation Facility
• Mystic Medical Associates LLC
• Mystic Medical Group, PC
• Mystic River Ambulance Association, Inc

• Geriatric Medicine (Family Medicine) Physician in Mystic, CT
• Providers in Mystic, CT by specialty
• Geriatric Medicine (Family Medicine) Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.