Individual provider Active NPI

Mark Lewis Wasserman, MD

  • Internal Medicine Physician
  • New Haven, CT
National Provider Identifier
1487680625
Registry record updated Dec 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036223 Issued in CT
Practice address
400 Columbus Ave
New Haven, CT 06519-1233
Phone
(203) 503-3250
Fax
(203) 503-3254
NPI assigned
Jun 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036223 CT Primary

Addresses

Primary practice location

400 Columbus Ave
New Haven, CT 06519-1233

Mailing address

400 Columbus Ave
New Haven, CT 06519-1233
Phone (203) 503-3250

Other identifiers 1

IdentifierTypeStateIssuer
004235900MedicaidCT

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
I20090910000334 CT Practitioner - Internal Medicine 5193870475 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Rutgers New Jersey Medical School, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Afc Physicians of Connecticut PCGroup PAC ID 5193966893, 39 clinicians

Practice addresses (Care Compare)

607 Main Ave
Suite 13
Norwalk, CT 06851-1058
Phone (203) 845-9100

Merit-based Incentive Payment System (MIPS)

Final score
77.63 of 100Reported as group
Quality
62.23
Improvement activities
40
Cost
81.29

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036223CTMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Afc Physicians of Connecticut, PC CurrentSince Jun 1, 2021 Accepting new patients
Afc Physicians of Connecticut, PC CurrentSince Jun 1, 2021 Accepting new patients
Griffin Faculty Physicians, Inc. Internal Medicine Past Accepting new patients

Locations

2 Main St
Danbury, CT 06810
Phone (203) 826-2140

607 Main Ave
Ste 13
Norwalk, CT 06851
Phone (203) 845-9100

1030 Boulevard
West Hartford, CT 06119
Phone (860) 986-6440

Organizations & group practices 3

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": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323993600000",
    "number": "1487680625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 COLUMBUS AVE",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065191233",
            "telephone_number": "203-503-3250",
            "fax_number": "203-503-3254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 COLUMBUS AVE",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065191233",
            "telephone_number": "203-503-3250",
            "fax_number": "203-503-3254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASSERMAN",
        "first_name": "MARK",
        "middle_name": "LEWIS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-22",
        "last_updated": "2011-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "036223",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004235900",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New Haven, CT

Sources for this page

Verify at the official NPI Registry.