Mariann M Clubb, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

036117 Issued in CT

Practice address

111 Founders PLZ
#300 C/O Ipms
East Hartford, CT 06108-3212

Phone

(860) 282-4137

Fax

(860) 282-0170

NPI assigned

Oct 31, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

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

Specialty

Anesthesiology

Education

University of Connecticut School of Medicine, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Integrated Anesthesia Associates LLCGroup PAC ID 1759281165, 402 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Hartford Hospital Hospital, Hartford, CT, CCN 070025

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.

• Integrated Anesthesia Associates LLC

  • Anesthesiology Physician
  • Shelton, CT
  • NPI 1881636397
  Medicare reassignment Care Compare group NPD

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

• Hartford Hospital

  • General Acute Care Hospital
  • Hartford, CT
  • NPI 1770696643
  Care Compare affiliation
• Hartford Hospital

  • General Acute Care Hospital
  • Hartford, CT
  • NPI 1902834880
  Care Compare affiliation

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

{
    "created_epoch": "1130716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1399334400000",
    "number": "1609867589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 FOUNDERS PLZ",
            "address_2": "#300 C/O IPMS",
            "city": "EAST HARTFORD",
            "state": "CT",
            "postal_code": "061083212",
            "telephone_number": "860-282-4137",
            "fax_number": "860-282-0170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 FOUNDERS PLZ",
            "address_2": "#300 C/O IPMS",
            "city": "EAST HARTFORD",
            "state": "CT",
            "postal_code": "061083212",
            "telephone_number": "860-282-4137",
            "fax_number": "860-282-0170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLUBB",
        "first_name": "MARIANN",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-31",
        "last_updated": "2014-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CT",
            "license": "036117",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001361170",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christus Medical Group
• Thomas Edward Ciesielski, M.D.
• Citrine Homecare Solutions, LLC
• Carol Marjorie Clarke-Montaque
• Brooke Josie Clavet
• Ryan Joseph Cochrane, LMSW
• Ann E Cocks, APRN
• Imani Cohen
• Colleen Coke
• Stephanie Jean Collin

• Anesthesiology Physician in East Hartford, CT
• Providers in East Hartford, CT by specialty
• Anesthesiology Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2014; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.