Connecticut Orthopaedic Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

CONNECTICUT ORTHOPAEDIC SURGERY CENTER, LLC

Practice address

205 Sub Way Drive
Milford, CT 06461

Phone

(860) 667-9542

Fax

(860) 667-2066

NPI assigned

Jan 22, 2019

Last updated

Nov 19, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lucille Formeister

Title

Manager

Phone

(860) 667-9542

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Listed as

Connecticut Orthopaedic Surgery CenterCCN 07C0001069

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Midstate Medical Center

  • General Acute Care Hospital
  • Meriden, CT
  • NPI 1154425288

  Member Of

  NPD member
• Orthopedic Associates of Hartford,PC

  • Durable Medical Equipment & Medical Supplies
  • Plainville, CT
  • NPI 1710238563

  Member Of

  NPD member

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John Paul Daigneault, M.D.

  • Orthopaedic Surgery Physician
  • Branford, CT
  • NPI 1477532489
  NPD
• Mark Gombotz

  • Physical Therapist
  • Old Lyme, CT
  • NPI 1922116185
  NPD
• Jeffrey Michael Klauser, M.D.

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Shelton, CT
  • NPI 1598924193
  NPD

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

{
    "created_epoch": "1548115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574121600000",
    "number": "1477017648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 SUB WAY",
            "city": "MILFORD",
            "state": "CT",
            "postal_code": "06461",
            "telephone_number": "860-667-9542",
            "fax_number": "860-667-2066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 SUB WAY DRIVE",
            "city": "MILFORD",
            "state": "CT",
            "postal_code": "06461",
            "telephone_number": "860-667-9542",
            "fax_number": "860-667-2066"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNECTICUT ORTHOPAEDIC SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-22",
        "last_updated": "2019-11-19",
        "status": "A",
        "authorized_official_last_name": "FORMEISTER",
        "authorized_official_first_name": "LUCILLE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "860-667-9542"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Connecticut Neurosurgery, PC
• Connecticut Orthopaedic Specialists, PC
• Connecticut Orthopaedic Specialists, PC (Connecticut Orthopaedics Sports Therapy and Rehab)
• Connecticut Orthopaedic Specialists, PC
• Connecticut Orthopaedic Specialists, PC
• Connecticut Team Physicians, PC
• Consilium LLC (Breakers Counseling LLC)
• Rachel Console, DC
• Julia R Contaxis, LCSW
• Robin Copperthwaite

• Ambulatory Surgical Clinic/Center in Milford, CT
• Providers in Milford, CT by specialty
• Ambulatory Surgical Clinic/Center in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.