Individual provider Active NPI

John William O'Brien, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Wallingford, CT
National Provider Identifier
1447288741
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
024998 Issued in CT
Practice address
Gaylord Farm Rd.
Wallingford, CT 06492
Phone
(203) 284-2800
Fax
(203) 679-3598
NPI assigned
Jun 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 024998 CT Primary

Addresses

Primary practice location

Gaylord Farm Rd.
Wallingford, CT 06492

Mailing address

Gaylord Farm Rd.
PO Box 400
Wallingford, CT 06492
Phone (203) 284-2800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
024998CTMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Raphael Faculty Physicians Past Accepting new patients
Radiologic Associates of Middletown PC Past Accepting new patients

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": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1447288741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "GAYLORD FARM RD.",
            "address_2": "PO BOX 400",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "06492",
            "telephone_number": "203-284-2800",
            "fax_number": "203-679-3598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "GAYLORD FARM RD.",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "06492",
            "telephone_number": "203-284-2800",
            "fax_number": "203-679-3598"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'BRIEN",
        "first_name": "JOHN",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CT",
            "license": "024998",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wallingford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.