NPIMap

Organization Active NPI

Hartford Healthcare Medical Group Specialists, LLC

  • Internal Medicine Physician
  • Bridgeport, CT
National Provider Identifier
1356945182
Registry record updated Nov 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
HARTFORD HEALTHCARE MEDICAL GROUP SPECIALISTS, LLC
Practice address
2979 Main St
Bridgeport, CT 06606-4284
Phone
(203) 382-2100
Fax
(203) 382-2110
NPI assigned
Nov 23, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2020

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

Authorized official

Name
Mark Bancroft Vye
Title
VP of Administration
Phone
(860) 972-7858

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X
PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213E00000X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X

Addresses

Primary practice location

2979 Main St
Bridgeport, CT 06606-4284

Mailing address

1290 Silas Deane Hwy
Wethersfield, CT 06109-4337
Phone (680) 972-9033

National Provider Directory

National Provider Directory
Tax ID family
Hartford Healthcare Medical Group Specialists PLLC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1606089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606089600000",
    "number": "1356945182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1290 SILAS DEANE HWY",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061094337",
            "telephone_number": "680-972-9033",
            "fax_number": "860-972-7040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2979 MAIN ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066064284",
            "telephone_number": "203-382-2100",
            "fax_number": "203-382-2110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARTFORD HEALTHCARE MEDICAL GROUP SPECIALISTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-23",
        "last_updated": "2020-11-23",
        "certification_date": "2020-11-23",
        "status": "A",
        "authorized_official_last_name": "VYE",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "BANCROFT",
        "authorized_official_title_or_position": "VP OF ADMINISTRATION",
        "authorized_official_telephone_number": "860-972-7858"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeport, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.