Individual provider Active NPI

Poonam Thakore, M.D.

  • Neonatal-Perinatal Medicine Physician
  • Bridgeport, CT
National Provider Identifier
1447612148
Registry record updated Aug 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
036159517 Issued in IL
Practice address
2800 Main St
Bridgeport, CT 06606-4201
Phone
(475) 210-5310
Fax
(475) 210-5784
NPI assigned
Mar 22, 2016
Last updated
Aug 5, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 62497 CT
Pediatrics Physician 208000000X 036159517 IL
Neonatal-Perinatal Medicine Physician 2080N0001X 036159517 IL Primary

Addresses

Primary practice location

2800 Main St
Bridgeport, CT 06606-4201

Mailing address

1290 Silas Deane Hwy
HHC-Cvo
Wethersfield, CT 06109-4337
Phone (860) 972-5507

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pthakore57444@sih.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, CT2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20220719001616 IL Practitioner - Pediatric Medicine 6305125790 Reassigns benefits to 1 organization
I20230602001335 CT Practitioner - Pediatric Medicine 6305125790 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
62497CTMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hartford Healthcare Medical Group Specialists, PLLC CurrentSince May 31, 2025 Accepting new patients
Hartford Healthcare Medical Group Specialists LLC CurrentSince May 31, 2025 Accepting new patients
Connecticut Children's Specialty Group, Inc. Pediatrics CurrentSince May 24, 2023 Accepting new patients
Connecticut Children's Specialty Group, Inc. Pediatrics CurrentSince May 24, 2023 Accepting new patients
Southern Illinois Medical Services, NFP CurrentSince Jul 25, 2022 Accepting new patients

Locations

2800 Main St
Bridgeport, CT 06606
Phone (203) 386-0366

24 Hospital Ave
Danbury, CT 06810
Phone (203) 739-7118

10 Columbus Blvd
Hartford, CT 06106
Phone (860) 837-5619

10 Columbus Blvd
Fl 4
Hartford, CT 06106
Phone (860) 837-5560

100 Retreat Ave
Fl 5
Hartford, CT 06106
Phone (860) 837-5206

282 Washington St
Hartford, CT 06106
Phone (860) 545-8950

80 Seymour St
Fl 5
Hartford, CT 06106
Phone (860) 545-8950

71 Haynes St
Manchester, CT 06040
Phone (860) 533-2981

435 Lewis Ave
Meriden, CT 06451
Phone (203) 284-1340

100 Grand St
New Britain, CT 06052
Phone (860) 224-5011

34 Maple St
Norwalk, CT 06850
Phone (203) 852-2000

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

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

1290 Silas Deane Hwy
Wethersfield, CT 06109
Phone (860) 972-6977

2601 W Main St
Carbondale, IL 62901
Phone (618) 351-7300

405 W Jackson St
Carbondale, IL 62901

Interoperability endpoints

  • Direct secure messaging: poonam.thakore@xdr.hhchealthdirect.org
  • Direct secure messaging: pthakore46362@connecticutchildrens.direct-ci.com
  • Direct secure messaging: pthakore57444@sih.direct-ci.com

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1458604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754352000000",
    "number": "1447612148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1290 SILAS DEANE HWY",
            "address_2": "HHC-CVO",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061094337",
            "telephone_number": "860-972-5507",
            "fax_number": "860-972-7040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 MAIN ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066064201",
            "telephone_number": "475-210-5310",
            "fax_number": "475-210-5784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THAKORE",
        "first_name": "POONAM",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-22",
        "last_updated": "2025-08-05",
        "certification_date": "2025-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CT",
            "license": "62497",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036159517",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "IL",
            "license": "036159517",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pthakore57444@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "405 W Jackson St",
            "city": "Carbondale",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629011462",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bridgeport, CT

Sources for this page

Verify at the official NPI Registry.