NPIMap

Individual provider Active NPI

Derek R Smith, MD

  • Neurology Physician
  • Norwich, CT
National Provider Identifier
1407869019
Registry record updated Jul 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
43390 Issued in CT
Practice address
One Towne Park Plaza
Norwich, CT 06360
Phone
(860) 886-1433
Fax
(860) 886-4644
NPI assigned
Aug 14, 2006
Last updated
Jul 19, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 43390 CT Primary

Addresses

Primary practice location

One Towne Park Plaza
Norwich, CT 06360

Mailing address

1 Towne Park PLZ
Norwich, CT 06360-2247
Phone (860) 886-1433

Other identifiers 1

IdentifierTypeStateIssuer
001433903MedicaidCT

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
I20050726000458 CT Practitioner - Neurology 3072559913 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
University of Texas Southwestern Medical School at Dallas, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Hartford Healthcare Medical Group Specialists PLLCGroup PAC ID 3173866241, 1,555 clinicians

Practice addresses (Care Compare)

1 Towne Park PLZ
Norwich, CT 06360-2247
Phone (860) 886-1433

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.42 of 100Reported as group
Quality
83.36
Promoting interoperability
100
Improvement activities
40
Cost
75.9

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
43390CTMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hartford Healthcare Medical Group Specialists, PLLC Neurology CurrentSince Jun 1, 2019 Accepting new patients
Hartford Healthcare Medical Group, Inc Neurology CurrentSince Sep 1, 2018 Accepting new patients
Hartford Healthcare Medical Group Specialists LLC CurrentSince Jun 1, 2019 Accepting new patients
The William W Backus Hospital CurrentSince Apr 20, 2015 Accepting new patients
William W Backus Hospital CurrentSince Apr 20, 2015 Accepting new patients
Hartford Healthcare Medical Group, Inc Past Accepting new patients

Locations

190 Universal Dr
Ste 101
North Haven, CT 06473
Phone (203) 234-5990

1 Towne Park Plz
Norwich, CT 06360
Phone (860) 886-1433

326 Washington St
Norwich, CT 06360
Phone (860) 701-0140

55 Meriden Ave
Ste 1D
Southington, CT 06489
Phone (860) 276-5144

1244 Storrs Rd
Storrs Mansfield, CT 06268
Phone (860) 724-2579

Organizations & group practices 6

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

Hospital & facility affiliations 5

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": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531958400000",
    "number": "1407869019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 TOWNE PARK PLZ",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063602247",
            "telephone_number": "860-886-1433",
            "fax_number": "860-886-4644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "ONE TOWNE PARK PLAZA",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "06360",
            "telephone_number": "860-886-1433",
            "fax_number": "860-886-4644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "DEREK",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-14",
        "last_updated": "2018-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CT",
            "license": "43390",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001433903",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Norwich, CT

Sources for this page

Verify at the official NPI Registry.