Edward G McKiernan IV, RPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

004917 Issued in CT

Practice address

115 Technology Dr
Ste A200
Trumbull, CT 06611-6338

Phone

(203) 268-5801

Fax

(203) 452-3688

NPI assigned

Aug 31, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• McKiernan Physical Therapy LLC

  dba Allied Health & Wellness Centers

  • Physical Therapist
  • Trumbull, CT
  • NPI 1841301561
  Medicare reassignment NPD Authorized official
• Northeast Medical Group, Inc.

  • Internal Medicine Physician
  • Bridgeport, CT
  • NPI 1043278351
  Medicare reassignment NPD

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287014400000",
    "number": "1497866107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 TECHNOLOGY DR",
            "address_2": "STE A200",
            "city": "TRUMBULL",
            "state": "CT",
            "postal_code": "066116338",
            "telephone_number": "203-268-5801",
            "fax_number": "203-452-3688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 TECHNOLOGY DR",
            "address_2": "STE A200",
            "city": "TRUMBULL",
            "state": "CT",
            "postal_code": "066116338",
            "telephone_number": "203-268-5801",
            "fax_number": "203-452-3688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKIERNAN",
        "first_name": "EDWARD",
        "middle_name": "G",
        "name_suffix": "IV",
        "credential": "RPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2010-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CT",
            "license": "004917",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PIN",
            "identifier": "3918034",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET PIN",
            "identifier": "2V5288",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA PIN",
            "identifier": "3515548",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD PIN",
            "identifier": "A2983697",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS PIN",
            "identifier": "080004917CT04",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Janis McDuffie
• William McHenry
• Christie McKenzie, PT
• Rachel Catherine Ameer McKeon, LMFT
• McKiernan Physical Therapy LLC (Allied Health & Wellness Centers)
• Kristensen McKinnie
• Nakida McKnight
• Julie McNeil, RN
• Jacqueline McSally, PA-C
• Victor M. Mejia, M.D.

• Physical Therapist in Trumbull, CT
• Providers in Trumbull, CT by specialty
• Physical Therapist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2010; 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.