Anthony Mongillo, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

023825 Issued in CT

Practice address

3180 Main St
Suite 301
Bridgeport, CT 06606-4237

Phone

(203) 373-9100

Fax

(203) 365-8492

NPI assigned

Apr 11, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• 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": "1144713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369958400000",
    "number": "1558324228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3180 MAIN ST",
            "address_2": "SUITE 301",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066064237",
            "telephone_number": "203-373-9100",
            "fax_number": "203-365-8492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3180 MAIN ST",
            "address_2": "SUITE 301",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066064237",
            "telephone_number": "203-373-9100",
            "fax_number": "203-365-8492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONGILLO",
        "first_name": "ANTHONY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-11",
        "last_updated": "2013-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "023825",
            "primary": true
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "CT",
            "license": "023825",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001238252",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jocelyn Marie Mokos, MSPT
• Alexandra Rey Molina
• Bonnie Molloy, CRNA
• Lori Jane Monaco, D.C.
• Nadia Mondestin, LADC, CRC
• Monitor My Health, Inc. (Monitor My Health)
• Elizabeth Erin Monks
• Michael B Montanaro, DDS
• Jeffrey Montano, PA.
• Alinette Monteiro, M.A, LCSW

• Internal Medicine Physician in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Internal Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.