NPIMap

Organization Active NPI

Northeast Medical Group, Inc

  • Cardiovascular Disease Physician
  • Fairfield, CT
National Provider Identifier
1366745267
Registry record updated Jul 31, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
NORTHEAST MEDICAL GROUP, INC
Practice address
1305 Post Rd
Suite 105
Fairfield, CT 06824-6016
Phone
(203) 292-2000
Fax
(203) 255-5212
NPI assigned
Dec 15, 2010
Organization subpart
Yes
Parent organization
NORTHEAST MEDICAL GROUP, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 31, 2013

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

Authorized official

Name
Dr. Robert Nordgren, M.D
Title
Ceo
Phone
(203) 384-3975

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RC0000X Primary

Addresses

Primary practice location

1305 Post Rd
Suite 105
Fairfield, CT 06824-6016

Mailing address

226 Mill Hill Ave
3Rd FL
Bridgeport, CT 06610-2826
Phone (203) 336-7353

Other names 1

  • Cardiac Specialists Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040123000522 CT Part B Supplier - Clinic/Group Practice 1254233836 Receives reassigned benefits from 2,166 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Northeast Medical Group Inc7 organizations share this tax ID, including this one
Part of
Northeast Medical Group Inc

Other organizations with this tax ID 6

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

Locations

4 Corporate Dr
Ste 286
Shelton, CT 06484
Phone (203) 929-9000

95 Armory Rd
Stratford, CT 06614
Phone (203) 384-3388

112 Quarry Rd
Ste 160
Trumbull, CT 06611
Phone (203) 551-7350

112 Quarry Rd
Ste 400
Trumbull, CT 06611
Phone (203) 333-8800

Practitioners 150

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

View all 150

NPI Registry JSON

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

{
    "created_epoch": "1292371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375228800000",
    "number": "1366745267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "226 MILL HILL AVE",
            "address_2": "3RD FL",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066102826",
            "telephone_number": "203-336-7353",
            "fax_number": "203-384-3829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 POST RD",
            "address_2": "SUITE 105",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068246016",
            "telephone_number": "203-292-2000",
            "fax_number": "203-255-5212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST MEDICAL GROUP, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NORTHEAST MEDICAL GROUP, INC",
        "enumeration_date": "2010-12-15",
        "last_updated": "2013-07-31",
        "status": "A",
        "authorized_official_last_name": "NORDGREN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "203-384-3975",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cardiac Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairfield, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2013; 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.