NPIMap

Individual provider Active NPI

John Jeffrey Nelson, M.D.

  • Internal Medicine Physician
  • Mystic, CT
National Provider Identifier
1376540005
Registry record updated Sep 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
034771 Issued in CT
Practice address
11 Main St Unit 11-205
Mystic, CT 06355-3654
Phone
(860) 421-1090
Fax
(860) 421-1091
NPI assigned
Jul 7, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 034771 CT Primary

Addresses

Primary practice location

11 Main St Unit 11-205
Mystic, CT 06355-3654

Mailing address

11 Main St Unit 11-205
Mystic, CT 06355-3654
Phone (860) 421-1090

Other identifiers 1

IdentifierTypeStateIssuer
001347716MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070309000340 CT Practitioner - Internal Medicine 6204939382 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Boston University School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Value in Prevention of Connecticut PLLCGroup PAC ID 9335680362, 2 clinicians

Practice addresses (Care Compare)

11 Main St
Suite 11 205
Mystic, CT 06355-3654
Phone (860) 421-1090

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.48 of 100Reported as apm
Quality
83.4
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
034771CTMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ipc Hospitalists of New England PC Internal Medicine CurrentSince Nov 18, 2009 Accepting new patients
Ipc Hospitalists of New England, P.C. Internal Medicine CurrentSince Nov 18, 2009 Accepting new patients
Value in Prevention of Connecticut PLLC Internal Medicine CurrentSince Aug 30, 2024 Accepting new patients
Hospital Medicine Associates LLC Internal Medicine CurrentSince Jul 1, 2017 Accepting new patients
Ipc Hospitalists of New England, P.C. Internal Medicine Current Accepting new patients
Sound Medical Associates, PC Internal Medicine Past Accepting new patients
Conncare Inc Internal Medicine Past Accepting new patients

Locations

11 Main St
Ste 11205
Mystic, CT 06355
Phone (860) 421-1090

11 Main St
Unit 11205
Mystic, CT 06355
Phone (860) 421-1090

11 Main St
Ste 11
Mystic, CT 06355

365 Montauk Ave
Rm 4
New London, CT 06320

365 Montauk Ave
New London, CT 06320
Phone (860) 271-4364

Interoperability endpoints

  • Direct secure messaging: john.nelson.1@31695.direct.athenahealth.com

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726012800000",
    "number": "1376540005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 MAIN ST UNIT 11-205",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "063553654",
            "telephone_number": "860-421-1090",
            "fax_number": "860-421-1091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 MAIN ST UNIT 11-205",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "063553654",
            "telephone_number": "860-421-1090",
            "fax_number": "860-421-1091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "JOHN",
        "middle_name": "JEFFREY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2024-09-11",
        "certification_date": "2024-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "034771",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001347716",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mystic, CT

Sources for this page

Verify at the official NPI Registry.