Active NPI
Ian Richard Cameron, M.D.
- Psychiatry Physician
- Glastonbury, CT
National Provider Identifier
1568404242
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 011816
- Practice address
- 200 Oak St
Glastonbury, CT 06033-2320 - Phone
- (860) 657-3602
- Fax
- (860) 657-4421
- NPI assigned
- Jun 10, 2006
- Last updated
- Jun 21, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 011816 | CT | Primary |
Addresses
Primary practice location
200 Oak St
Glastonbury, CT 06033-2320
Mailing address
200 Oak St
Suite C
Glastonbury, CT 06033-2320
Phone (860) 657-3602
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: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Apr 1, 2013 through Apr 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11816 | CT | MD | Oral & Maxillofacial Surgery (D.M.D.) |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Intercommunity, Inc. | Past | Accepting new patients | |
| Intercommunity, Inc. | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Adult Mental Health Clinic/Center
- Glastonbury, CT
- NPI 1558699256
-
- Primary Care Clinic/Center
- East Hartford, CT
- NPI 1073548533
-
- Federally Qualified Health Center (FQHC)
- East Hartford, CT
- NPI 1962896548
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149897600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1466467200000",
"number": "1568404242",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 OAK ST",
"address_2": "SUITE C",
"city": "GLASTONBURY",
"state": "CT",
"postal_code": "060332320",
"telephone_number": "860-657-3602",
"fax_number": "860-657-4421"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 OAK ST",
"city": "GLASTONBURY",
"state": "CT",
"postal_code": "060332320",
"telephone_number": "860-657-3602",
"fax_number": "860-657-4421"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAMERON",
"first_name": "IAN",
"middle_name": "RICHARD",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-10",
"last_updated": "2016-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CT",
"license": "011816",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glastonbury, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2016; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.