Individual provider Active NPI

Nancy G.M. Miner, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Manchester, CT
National Provider Identifier
1487772943
Registry record updated May 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
002358 Issued in CT
Practice address
587 Middle Tpke E
Manchester, CT 06040-3731
Phone
(860) 646-3888
Fax
(860) 645-4132
NPI assigned
Mar 26, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 23, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 002358 CT Primary

Addresses

Primary practice location

587 Middle Tpke E
Manchester, CT 06040-3731

Mailing address

587 Middle Tpke E
Manchester, CT 06040-3731
Phone (860) 646-3888

Other identifiers 1

IdentifierTypeStateIssuer
004040655MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT, TX2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040428000167 CT Practitioner - Certified Clinical Nurse Specialist (CNS) 7911994397 Reassigns benefits to 2 organizations
I20190312000084 TX Practitioner - Certified Clinical Nurse Specialist (CNS) 7911994397 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Clinical Nurse Specialist (CNS)
Education
Other, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Connecticut Behavioral Health Assoc PCGroup PAC ID 4385532373, 38 clinicians
Mashantucket Pequot Tribal CouncilGroup PAC ID 8628295599, 3 clinicians

Practice addresses (Care Compare)

616 Gold Star Hwy
Groton, CT 06340-6221
Phone (860) 449-0020

75 Norwich Westerly Rd
Ledyard, CT 06339-1146

75 Route 2
Ledyard, CT 06339

75 Route 2
Ledyard, CT 06339-1128
Phone (860) 312-8014

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Specialist, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
002358CTMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Connecticut Behavioral Health Assoc, P.C. Psychiatric/Mental Health CurrentSince Sep 9, 2019 Accepting new patients
Mashantucket Pequot Tribal Council CurrentSince Nov 18, 2018 Accepting new patients
Medoptions Behavioral Health Assoc, LLC Past Accepting new patients
Community Health Resources, Inc. Past Accepting new patients

Locations

616 Gold Star Hwy
Groton, CT 06340
Phone (860) 449-0020

75 Route 2
Ledyard, CT 06339
Phone (860) 312-8000

41 Faire Harbour Pl
New London, CT 06320
Phone (860) 437-6914

22 Case St
Norwich, CT 06360
Phone (860) 437-6914

Interoperability endpoints

  • Direct secure messaging: nancy.miner.1@32885.direct.athenahealth.com

Organizations & group practices 5

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": "1174867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369267200000",
    "number": "1487772943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "587 MIDDLE TPKE E",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060403731",
            "telephone_number": "860-646-3888",
            "fax_number": "860-645-4132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "587 MIDDLE TPKE E",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060403731",
            "telephone_number": "860-646-3888",
            "fax_number": "860-645-4132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINER",
        "first_name": "NANCY",
        "middle_name": "G.M.",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-26",
        "last_updated": "2013-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CT",
            "license": "002358",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004040655",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, CT

Sources for this page

Verify at the official NPI Registry.