Individual provider Active NPI

Damianos Kokkinidis, M.D

  • Cardiovascular Disease Physician
  • Waterford, CT
National Provider Identifier
1477084838
Registry record updated Aug 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
1.066150 Issued in CT
Practice address
196 Parkway South
Suite 103
Waterford, CT 06385
Phone
(860) 443-4383
NPI assigned
Mar 27, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 66150 CT
Cardiovascular Disease Physician 207RC0000X 1.066150 CT Primary

Addresses

Primary practice location

196 Parkway South
Suite 103
Waterford, CT 06385

Mailing address

196 Parkway South
Suite 103
Waterford, CT 06385
Phone (860) 443-4383

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
I20230817001540 CT Practitioner - Cardiovascular Disease (Cardiology) 2062837099 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northeast Medical Group IncGroup PAC ID 1254233836, 1,357 clinicians

Practice addresses (Care Compare)

196 Pkwy S
Suite 103
Waterford, CT 06385
Phone (860) 443-4383

Hospital & facility affiliations

  • Lawrence & Memorial Hospital Hospital, New London, CT, CCN 070007
  • Yale-New Haven Hospital Hospital, New Haven, CT, CCN 070022
  • Westerly Hospital Hospital, Westerly, RI, CCN 410013
  • William W Backus Hospital Hospital, Norwich, CT, CCN 070024

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
86.54
Promoting interoperability
99.98
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
66150CTMDInternal Medicine Physician
1.066150CTMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Medical Group, Inc. Internal Medicine CurrentSince Aug 28, 2023 Accepting new patients

Locations

52 Hazelnut Hill Rd
Groton, CT 06340
Phone (860) 446-8265

20 York St
North Haven, CT 06510
Phone (203) 688-2433

95 Armory Rd
Stratford, CT 06614
Phone (203) 384-3388

196 Parkway S
Ste 103
Waterford, CT 06385
Phone (860) 443-4383

196 Parkway S
Unit 103
Waterford, CT 06385

Interoperability endpoints

  • Direct secure messaging: dkokkinidis463655@direct.ynhh.org

Organizations & group practices 1

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 8

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": "1490572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691107200000",
    "number": "1477084838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "196 PARKWAY SOUTH",
            "address_2": "SUITE 103",
            "city": "WATERFORD",
            "state": "CT",
            "postal_code": "06385",
            "telephone_number": "860-443-4383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "196 PARKWAY SOUTH",
            "address_2": "SUITE 103",
            "city": "WATERFORD",
            "state": "CT",
            "postal_code": "06385",
            "telephone_number": "860-443-4383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOKKINIDIS",
        "first_name": "DAMIANOS",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-27",
        "last_updated": "2023-08-04",
        "certification_date": "2023-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "66150",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CT",
            "license": "1.066150",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterford, CT

Sources for this page

Verify at the official NPI Registry.