NPIMap

Organization Active NPI

Connecticut Geriatric Specialty Group, PC

  • Geriatric Medicine (Family Medicine) Physician
  • West Hartford, CT
National Provider Identifier
1457573933
Registry record updated Sep 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
Legal business name
CONNECTICUT GERIATRIC SPECIALTY GROUP, PC
Practice address
1 Abrahms Boulevard
West Hartford, CT 06117
Phone
(860) 523-3854
Fax
(860) 523-3828
NPI assigned
May 3, 2007
Organization subpart
Yes
Parent organization
HEBREW HOME & HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 4, 2013

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

Authorized official

Name
Mr. David Houle
Title
Vice President/Cfo
Phone
(860) 523-3895

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207QG0300X Primary
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X
Geriatric Medicine (Internal Medicine) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RG0300X
Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363L00000X
Adult Health Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LA2200X
Gerontology Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LG0600X

Addresses

Primary practice location

1 Abrahms Boulevard
West Hartford, CT 06117

Mailing address

1 Abrahms Boulevard
West Hartford, CT 06117
Phone (860) 523-3854

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080521000368 CT Part B Supplier - Clinic/Group Practice 0547339236 Receives reassigned benefits from 4 practitioners
Practice locations: West Hartford, CT

National Provider Directory

National Provider Directory
Tax ID family
Connecticut Geriatric Specialty Group PC2 organizations share this tax ID, including this one
Part of
Hebrew Health Care

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378252800000",
    "number": "1457573933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 ABRAHMS BOULEVARD",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "06117",
            "telephone_number": "860-523-3854",
            "fax_number": "860-523-3828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 ABRAHMS BOULEVARD",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "06117",
            "telephone_number": "860-523-3854",
            "fax_number": "860-523-3828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNECTICUT GERIATRIC SPECIALTY GROUP, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HEBREW HOME & HOSPITAL",
        "enumeration_date": "2007-05-03",
        "last_updated": "2013-09-04",
        "status": "A",
        "authorized_official_last_name": "HOULE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "VICE PRESIDENT/CFO",
        "authorized_official_telephone_number": "860-523-3895",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Hartford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.