Individual provider Active NPI

Edward J Watson, M.D.

  • Obstetrics & Gynecology Physician
  • New London, CT
National Provider Identifier
1528031804
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
029712 Issued in CT
Practice address
471 Montauk Ave
New London, CT 06320-4614
Phone
(860) 443-4148
Fax
(860) 442-3805
NPI assigned
Feb 8, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 029712 CT Primary

Addresses

Primary practice location

471 Montauk Ave
New London, CT 06320-4614

Mailing address

471 Montauk Ave
New London, CT 06320-4614
Phone (860) 443-4148

Other identifiers 1

IdentifierTypeStateIssuer
001297127MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Care Compare profile

Medicare Care Compare

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
029712CTMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Medical Group, Inc. Obstetrics & Gynecology CurrentSince Apr 1, 2017 Accepting new patients
Women'S Health of Westerly, LLC Obstetrics & Gynecology PastSince Jun 20, 2017 Accepting new patients

Locations

226 Mill Hill Ave
Ste 3
Bridgeport, CT 06610
Phone (203) 384-3394

194 Howard St
New London, CT 06320
Phone (860) 442-0564

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

40 Boston Post Rd
Waterford, CT 06385
Phone (860) 271-4900

45 East Ave
Westerly, RI 02891
Phone (401) 596-6000

25 Wells St
Westerly, RI 02891
Phone (401) 348-3325

45 Wells St
Ste 104
Westerly, RI 02891
Phone (401) 348-0008

Organizations & group practices 2

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": "1139356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1528031804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "471 MONTAUK AVE",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063204614",
            "telephone_number": "860-443-4148",
            "fax_number": "860-442-3805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "471 MONTAUK AVE",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063204614",
            "telephone_number": "860-443-4148",
            "fax_number": "860-442-3805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATSON",
        "first_name": "EDWARD",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CT",
            "license": "029712",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001297127",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New London, CT

Sources for this page

Verify at the official NPI Registry.