Amy Douglass, M.D., MPH

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

63602 Issued in CT

Practice address

365 Montauk Ave
New London, CT 06320-4769

Phone

(860) 442-0711

NPI assigned

Jul 16, 2013

Last updated

Dec 1, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Enrolled in CT

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.

Enrollment records 1

Specialty

Emergency Medicine

Education

University of California, Davis School of Medicine, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lawrence and Memorial Hospital Inc.Group PAC ID 5991792053, 50 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Lawrence & Memorial Hospital Hospital, New London, CT, CCN 070007

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: adouglass18701@middlesexhealthprd.direct-ci.com
• Direct secure messaging: adouglass434740@direct.ynhh.org

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.

• Lawrence and Memorial Hospital, Inc.

  dba Lawrence and Memorial Hospital

  • General Acute Care Hospital
  • New London, CT
  • NPI 1073530879

  Emergency Medicine

  Medicare reassignment Care Compare group NPD
• Middlesex Hospital

  • General Acute Care Hospital
  • Middletown, CT
  • NPI 1760454334
  Medicare reassignment NPD
• Lawrence and Memorial Hospital, Inc.

  dba Yale New Haven Health Pharmacy - Lawrence and Memorial Hospital

  • Community/Retail Pharmacy
  • New London, CT
  • NPI 1184402331
  NPD
• Middlesex Hospital

  dba Middlesex Hospital Homecare and Hospice

  • Community Based Hospice Care Agency
  • Middletown, CT
  • NPI 1003873233
  NPD

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

• Lawrence and Memorial Hospital, Inc.

  dba Lawrence and Memorial Hospital

  • General Acute Care Hospital
  • New London, CT
  • NPI 1073530879
  Care Compare affiliation
• Lawrence and Memorial Hospital, Inc.

  dba Lawrence and Memorial Hospital

  • General Acute Care Hospital
  • New London, CT
  • NPI 1700092459
  Care Compare affiliation

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

{
    "created_epoch": "1373932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606780800000",
    "number": "1356782601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "365 MONTAUK AVE",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063204769",
            "telephone_number": "860-442-0711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "365 MONTAUK AVE",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063204769",
            "telephone_number": "860-442-0711"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 W Carson St",
            "address_purpose": "LOCATION",
            "city": "Torrance",
            "state": "CA",
            "postal_code": "905022004",
            "country_code": "US",
            "telephone_number": "310-222-3501",
            "fax_number": "310-782-1763",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOUGLASS",
        "first_name": "AMY",
        "name_prefix": "Dr.",
        "credential": "M.D., MPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-16",
        "last_updated": "2020-12-01",
        "certification_date": "2020-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CT",
            "license": "63602",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hartmut A Doerwaldt, MD
• Lauren Marcus Doherty, MD
• Patrick F Doherty, M.D.
• Joann Donnel, LNM
• Donnelly Orthotic and Prosthetic Systems LLC
• Mary T Doyle
• Dr Demarco Zuckerbraun Consulting LLC
• Michael James Drechsler, DO
• John Jay Driscoll
• Stephanie Drouin, LMT

• Emergency Medicine Physician in New London, CT
• Providers in New London, CT by specialty
• Emergency Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.