Individual provider Active NPI

Deenna Nealon, APRN

  • Family Nurse Practitioner
  • Trumbull, CT
National Provider Identifier
1609880905
Registry record updated Dec 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
001767 Issued in CT
Practice address
2 Corporate Drive, Suite 110
Fairfield County Integrative Family Medicine, LLC
Trumbull, CT 06611-1376
Phone
(203) 445-9060
Fax
(203) 445-9093
NPI assigned
Jul 29, 2006
Last updated
Dec 17, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 001767 CT Primary

Addresses

Primary practice location

2 Corporate Drive, Suite 110
Fairfield County Integrative Family Medicine, LLC
Trumbull, CT 06611-1376

Mailing address

2 Corporate Drive, Suite 110
Fairfield County Integrative Family Medicine, LLC
Trumbull, CT 06611-1376
Phone (203) 445-9060

Other identifiers 2

IdentifierTypeStateIssuer
D400089302OtherCTMEDICARE PTAN
0042048800MedicaidCT

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040317001011 CT Practitioner - Nurse Practitioner 8729978390 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1990
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

324 Elm St
Suite 203a
Monroe, CT 06468-2282
Phone (203) 220-6306

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
001767CTMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fairfield Health and Wellness Solutions, LLC Family CurrentSince Dec 2, 2015 Accepting new patients

Locations

324 Elm St
Ste 203A
Monroe, CT 06468
Phone (203) 220-6306

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1387238400000",
    "number": "1609880905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 CORPORATE DRIVE, SUITE 110",
            "address_2": "FAIRFIELD COUNTY INTEGRATIVE FAMILY MEDICINE, LLC",
            "city": "TRUMBULL",
            "state": "CT",
            "postal_code": "066111376",
            "telephone_number": "203-445-9060",
            "fax_number": "203-445-9093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 CORPORATE DRIVE, SUITE 110",
            "address_2": "FAIRFIELD COUNTY INTEGRATIVE FAMILY MEDICINE, LLC",
            "city": "TRUMBULL",
            "state": "CT",
            "postal_code": "066111376",
            "telephone_number": "203-445-9060",
            "fax_number": "203-445-9093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEALON",
        "first_name": "DEENNA",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-29",
        "last_updated": "2013-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "001767",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "D400089302",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0042048800",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Trumbull, CT

Sources for this page

Verify at the official NPI Registry.