Individual provider Active NPI

Kenneth Ward, M.D.

  • Family Medicine Physician
  • Shelton, CT
National Provider Identifier
1386700201
Registry record updated May 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
023564 Issued in CT
Practice address
110 Commerce Dr
Shelton, CT 06484-6244
Phone
(203) 929-7331
Fax
(203) 925-0330
NPI assigned
Dec 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 17, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 023564 CT Primary

Addresses

Primary practice location

110 Commerce Dr
Shelton, CT 06484-6244

Mailing address

67 Maple Ave
Derby, CT 06418-1328
Phone (203) 732-1330

Other identifiers 1

IdentifierTypeStateIssuer
001235647MedicaidCT

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20100901000438 CT Practitioner - Family Practice 5991840787 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
023564CTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Griffin Faculty Physicians, Inc. CurrentSince May 28, 2015 Accepting new patients
The Griffin Hospital Past Accepting new patients

Locations

67 Maple Ave
Derby, CT 06418
Phone (203) 732-0699

130 Division St
Derby, CT 06418
Phone (203) 732-1330

330 Bridgeport Ave
Shelton, CT 06484
Phone (203) 538-0020

110 Commerce Dr
Shelton, CT 06484
Phone (203) 426-5554

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558051200000",
    "number": "1386700201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 MAPLE AVE",
            "city": "DERBY",
            "state": "CT",
            "postal_code": "064181328",
            "telephone_number": "203-732-1330",
            "fax_number": "203-732-1332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 COMMERCE DR",
            "city": "SHELTON",
            "state": "CT",
            "postal_code": "064846244",
            "telephone_number": "203-929-7331",
            "fax_number": "203-925-0330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WARD",
        "first_name": "KENNETH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-28",
        "last_updated": "2019-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CT",
            "license": "023564",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001235647",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelton, CT

Sources for this page

Verify at the official NPI Registry.