Individual provider Active NPI

Martin Mark Keibel

  • Family Medicine Physician
  • Manchester, CT
National Provider Identifier
1427067339
Registry record updated Oct 31, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
023567 Issued in CT
Practice address
574 Middle Tpke E
Manchester, CT 06040-3730
Phone
(860) 646-4334
Fax
(860) 646-7020
NPI assigned
Aug 7, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 31, 2007

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 023567 CT Primary

Addresses

Primary practice location

574 Middle Tpke E
Manchester, CT 06040-3730

Mailing address

574 Middle Tpke E
Manchester, CT 06040-3730
Phone (860) 646-4334

Other identifiers 1

IdentifierTypeStateIssuer
P00064445OtherCTMEDICARE RR

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
I20100928000404 CT Practitioner - Family Practice 6002891694 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
State University of New York Downstate Medical Center, 1977
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Hartford Healthcare Medical Group IncGroup PAC ID 1153573902, 257 clinicians

Practice addresses (Care Compare)

55 Meriden Ave
Suite 1D
Southington, CT 06489-3239
Phone (860) 276-5144

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

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
023567CTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hartford Healthcare Medical Group, Inc Family Medicine CurrentSince Oct 1, 2019 Accepting new patients
Hartford Healthcare Medical Group, Inc Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Eastern Connecticut Medical Professionals Foundation Inc Family Medicine Past Accepting new patients
Healthwise Medical Associates, LLP Family Medicine Past Accepting new patients
Eastern Connecticut Medical Professionals Foundation, Inc Past Accepting new patients

Locations

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

Interoperability endpoints

  • Direct secure messaging: martin.keibel@xdr.hhchealthdirect.org

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 and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1154908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193788800000",
    "number": "1427067339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "574 MIDDLE TPKE E",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060403730",
            "telephone_number": "860-646-4334",
            "fax_number": "860-646-7020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "574 MIDDLE TPKE E",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060403730",
            "telephone_number": "860-646-4334",
            "fax_number": "860-646-7020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEIBEL",
        "first_name": "MARTIN",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-07",
        "last_updated": "2007-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CT",
            "license": "023567",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "P00064445",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, CT

Sources for this page

Verify at the official NPI Registry.