NPIMap

Organization Active NPI

Trumbull Medical Practice

  • Internal Medicine Physician
  • Trumbull, CT
National Provider Identifier
1568594554
Registry record updated Mar 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
038698 Issued in CT
Legal business name
TRUMBULL MEDICAL PRACTICE
Practice address
115 Technology Dr
A303
Trumbull, CT 06611-6337
Phone
(203) 268-4884
Fax
(203) 268-9371
NPI assigned
Mar 12, 2007
Last updated
Mar 4, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2008

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

Authorized official

Name
Dr. John A Flores, M.D.NPI 1154341659
Title
Medical Director
Phone
(203) 268-4884

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 038698 CT Primary

Addresses

Primary practice location

115 Technology Dr
A303
Trumbull, CT 06611-6337

Mailing address

115 Technology Dr
A303
Trumbull, CT 06611-6337
Phone (203) 268-4884

Other identifiers 6

IdentifierTypeStateIssuer
745874OtherCTCONNECTICARE
1541597OtherCIGNA
00138698111MedicaidCT
2338437OtherCTAETNA
OV7401OtherCTHEALTHNET
010038698CT01OtherCTBCBS

National Provider Directory

National Provider Directory

Locations

115 Technology Dr
Unit A303
Trumbull, CT 06611
Phone (203) 268-4884

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204588800000",
    "number": "1568594554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 TECHNOLOGY DR",
            "address_2": "A303",
            "city": "TRUMBULL",
            "state": "CT",
            "postal_code": "066116337",
            "telephone_number": "203-268-4884",
            "fax_number": "203-268-9371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 TECHNOLOGY DR",
            "address_2": "A303",
            "city": "TRUMBULL",
            "state": "CT",
            "postal_code": "066116337",
            "telephone_number": "203-268-4884",
            "fax_number": "203-268-9371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRUMBULL MEDICAL PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-12",
        "last_updated": "2008-03-04",
        "status": "A",
        "authorized_official_last_name": "FLORES",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "203-268-4884",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "038698",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONNECTICARE",
            "identifier": "745874",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "1541597",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00138698111",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2338437",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "OV7401",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "010038698CT01",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Trumbull, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.