NPIMap

Individual provider Active NPI

Hanna Kackielo, MD

  • Internal Medicine Physician
  • Norwich, CT
National Provider Identifier
1598714701
Registry record updated Jun 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
037461 Issued in CT
Practice address
1 Towne Park PLZ
Norwich, CT 06360-2247
Phone
(860) 887-0010
Fax
(860) 887-0178
NPI assigned
May 8, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 19, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X 037461 CT
Internal Medicine Physician 207R00000X 037461 CT Primary

Addresses

Primary practice location

1 Towne Park PLZ
Norwich, CT 06360-2247

Mailing address

1 Towne Park PLZ
Norwich, CT 06360-2247

Other identifiers 1

IdentifierTypeStateIssuer
001374610MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040616000583 CT Practitioner - Internal Medicine 0749264943 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Internal Medicine Group LLCGroup PAC ID 6204810401, 3 clinicians

Practice addresses (Care Compare)

1 Towne Park PLZ
Norwich, CT 06360-2247
Phone (860) 887-0010

Hospital & facility affiliations

  • Hartford Healthcare at Home Home health agency, East Hartford, CT, CCN 077041
  • Masonicare Home Health & Hospice, Inc Home health agency, Wallingford, CT, CCN 077159
  • Atrinity Home Health Home health agency, Wallingford, CT, CCN 077254
  • William W Backus Hospital Hospital, Norwich, CT, CCN 070024
  • Lawrence & Memorial Hospital Hospital, New London, CT, CCN 070007

Merit-based Incentive Payment System (MIPS)

Final score
94.48 of 100Reported as apm
Quality
83.4
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
037461CTMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Internal Medicine Group LLC Geriatric Medicine CurrentSince Aug 1, 2001 Accepting new patients
Cornelio R Hong MD Internal Medicine Past Accepting new patients

Locations

1 Towne Park Plz
Norwich, CT 06360
Phone (860) 886-1433

130 New London Tpke
Norwich, CT 06360
Phone (860) 886-0651

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1147046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592524800000",
    "number": "1598714701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 TOWNE PARK PLZ",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063602247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 TOWNE PARK PLZ",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063602247",
            "telephone_number": "860-887-0010",
            "fax_number": "860-887-0178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KACKIELO",
        "first_name": "HANNA",
        "name_prefix": "Mrs.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-08",
        "last_updated": "2020-06-19",
        "certification_date": "2020-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "CT",
            "license": "037461",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "037461",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001374610",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Norwich, CT

Sources for this page

Verify at the official NPI Registry.