NPIMap

Organization Active NPI

Connecticut Children's Medical Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Hartford, CT
National Provider Identifier
1578106951
Registry record updated Feb 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
CONNECTICUT CHILDREN'S MEDICAL CENTER
Practice address
282 Washington St
Hartford, CT 06106-3322
Phone
(860) 545-9000
NPI assigned
Oct 18, 2019
Last updated
Feb 25, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
CONNECTICUT CHILDREN'S MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 25, 2020

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

Authorized official

Name
Rachael Jacobsen
Title
Senior Rev Cycle Analyst
Phone
(860) 837-6325

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X Primary

Addresses

Primary practice location

282 Washington St
Hartford, CT 06106-3322

Mailing address

10 Columbus Blvd
Hartford, CT 06106-1976
Phone (860) 837-6325

Other names 1

  • Connecticut Children's Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200210001378 CT Part A Provider - End-Stage Renal Disease Facility (ESRD) 7618031907 Practice locations: Hartford, CT

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Connecticut Children's Medical CenterCCN 072314
Ownership
Profit
Certified
May 18, 2020
Medicare certification status
ActiveFrom the Provider of Services file
Dialysis stations
3

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

National Provider Directory

National Provider Directory
Tax ID family
Newington Child Hosp-Su6 organizations share this tax ID, including this one
Part of
Newington Child Hosp-Su

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

105 Newtown Rd
Ste C
Danbury, CT 06810
Phone (203) 791-9011

399 Farmington Ave
Farmington, CT 06032
Phone 2032372477222

310 Western Blvd
Glastonbury, CT 06033
Phone (860) 837-9877

191 Post Rd W
Westport, CT 06880
Phone (203) 221-2823

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Connecticut Children'sCheshire, CT, CCN 077251 Home health agency 5% Or Greater Direct Ownership Interest (100%) Oct 11, 2024

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 145

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.

View all 145

NPI Registry JSON

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

{
    "created_epoch": "1571356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582588800000",
    "number": "1578106951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 COLUMBUS BLVD",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061061976",
            "telephone_number": "860-837-6325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "282 WASHINGTON ST",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061063322",
            "telephone_number": "860-545-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNECTICUT CHILDREN'S MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CONNECTICUT CHILDREN'S MEDICAL CENTER",
        "enumeration_date": "2019-10-18",
        "last_updated": "2020-02-25",
        "certification_date": "2020-02-25",
        "status": "A",
        "authorized_official_last_name": "JACOBSEN",
        "authorized_official_first_name": "RACHAEL",
        "authorized_official_title_or_position": "SENIOR REV CYCLE ANALYST",
        "authorized_official_telephone_number": "860-837-6325"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Connecticut Children's",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Hartford, CT

Sources for this page

Verify at the official NPI Registry.