Michelle N Watson, M.D.
Individual provider Active NPI Pediatrics Physician · Gales Ferry, CT
NPI 1487743928 · NPPES record last updated Jan 22, 2013
Key facts
- NPI
- 1487743928
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 038829 (CT)
- Practice address
- 1527 Route 12
Gales Ferry, CT 06335-1800 - Phone
- (860) 464-7248
- Fax
- (860) 464-0125
- NPI assigned
- Oct 12, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Pediatric Medicine
- Education
- Other, 1996
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Northeast Medical Group Inc
Practice addresses (Care Compare)
1527 Route 12
Gales Ferry, CT 06335-1800
Phone (860) 464-7248
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190604003183 | CT | Practitioner - Pediatric Medicine | 7416280516 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 038829 | CT | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northeast Medical Group, Inc. | Pediatrics | Current |
Accepting new patients |
Locations
1527 Route 12
Gales Ferry, CT 06335
Phone (860) 464-7248
365 Montauk Ave
New London, CT 06320
Phone (860) 271-4364
633 Middlesex Tpke
Old Saybrook, CT 06475
Phone (860) 388-5831
95 Armory Rd
Stratford, CT 06614
Phone (203) 384-3388
Interoperability endpoints
- mwatson48338@direct.ynhh.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 038829 | CT | Yes |
Addresses
Primary practice location
1527 Route 12
Gales Ferry, CT 06335-1800
Mailing address
1527 Route 12
Gales Ferry, CT 06335-1800
Phone (860) 464-7248
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1241233 | Other | UNITED HEALTH CARE | |
| OV9498 | Other | HEALTH NET | |
| 061223645 | Other | CIGNA | |
| 001388299 | Medicaid | CT | |
| P2364696 | Other | OXFORD | |
| 010038829CT01 | Other | BLUE CROSS | |
| 038829 | Other | CONNECTICARE |
Other providers in Gales Ferry, CT
- Lori Soriano
- Lauryl Spera
- Marie F Stone
- Thriving Potential, PLLC
- Emily Traglia
- Waves of Growth Therapy, LLC
- Lynn Marie Wisniewski
- Michelle Lynn Woods-Sweatland
- Jonathan Zane
All providers in Gales Ferry, CT · Pediatrics Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 22, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.