John R. West MD Inc

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

Legal business name

JOHN R. WEST MD INC

Practice address

34 Water St
Suite 2
Mystic, CT 06355-2524

Phone

(860) 572-9994

Fax

(860) 572-9930

NPI assigned

Jul 7, 2006

Organization subpart

No

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

Authorized official

Name

Dr. John Robert West Jr., M.D.NPI 1487606117

Title

President

Phone

(860) 572-9994

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Seaport Dermatology Doing business as

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 4

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

• John Robert West Jr., M.D.

  • MOHS-Micrographic Surgery Physician
  • Mystic, CT
  • NPI 1487606117

  CT, Mohs-Micrographic Surgery

  Medicare reassignment Care Compare group NPD Authorized official
• Meghan B Brunnock, PA-C

  • Physician Assistant
  • Mystic, CT
  • NPI 1063500841

  CT

  Medicare reassignment Care Compare group
• William J Wray, P.A.

  • Physician Assistant
  • Mystic, CT
  • NPI 1043278773

  CT

  Medicare reassignment Care Compare group
• Baokim Nguyen Bonelli, PA-C

  • Physician Assistant
  • Westerly, RI
  • NPI 1841627353
  Care Compare group

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360108800000",
    "number": "1376575324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34 WATER ST # 2",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "063552524",
            "telephone_number": "860-572-9994",
            "fax_number": "860-572-9930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34 WATER ST",
            "address_2": "SUITE 2",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "063552524",
            "telephone_number": "860-572-9994",
            "fax_number": "860-572-9930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN R. WEST MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2013-02-06",
        "status": "A",
        "authorized_official_last_name": "WEST",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "860-572-9994",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "010044204CT01",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Seaport Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• James P. Watts, DMD
• Christopher Paul James
• Giulia Jaramillo, MS LMFT
• Jason T Cerro LPC Inc.
• Jean Allbee-Roberson LMFT LLC
• Jon Gaudio LLC
• Mary E Jordan, LMFT, LADC, CEAP
• Edwin Dej. Perry Joseph III, PH.D.
• Kairos Therapy Center LLC
• Kathys Breastfeeding Nook

• All providers in Mystic, CT
• MOHS-Micrographic Surgery Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.