Individual provider Active NPI

Lawrence Rifkin, MD

  • Pediatrics Physician
  • Bloomfield, CT
National Provider Identifier
1629091798
Registry record updated Aug 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
032317 Issued in CT
Practice address
580 Cottage Grove Rd Ste 103
Bloomfield, CT 06002-3088
Phone
(860) 243-5225
Fax
(860) 769-6757
NPI assigned
Jul 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 032317 CT Primary
Pediatric Adolescent Medicine Physician 2080A0000X 032317 CT

Addresses

Primary practice location

580 Cottage Grove Rd Ste 103
Bloomfield, CT 06002-3088

Mailing address

291 Stanley Dr
Glastonbury, CT 06033-2621
Phone (860) 918-1275

Other identifiers 2

IdentifierTypeStateIssuer
001323170MedicaidCT
010032317CT03OtherCTANTHEM BLUE SHIELD

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lawrence.rifkin.1@27673.direct.athenahealth.com

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150403000525 CT Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 0446578330

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
032317CTMDPediatric Adolescent Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Collins Medical Associates 2 PC Pediatrics Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: lawrence.rifkin.1@27673.direct.athenahealth.com

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722470400000",
    "number": "1629091798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "291 STANLEY DR",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060332621",
            "telephone_number": "860-918-1275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "580 COTTAGE GROVE RD STE 103",
            "city": "BLOOMFIELD",
            "state": "CT",
            "postal_code": "060023088",
            "telephone_number": "860-243-5225",
            "fax_number": "860-769-6757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIFKIN",
        "first_name": "LAWRENCE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2024-08-01",
        "certification_date": "2024-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CT",
            "license": "032317",
            "primary": true
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "CT",
            "license": "032317",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001323170",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE SHIELD",
            "identifier": "010032317CT03",
            "state": "CT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lawrence.rifkin.1@27673.direct.athenahealth.com",
            "affiliation": "N",
            "address_1": "580 Cottage Grove Rd Ste 103",
            "city": "Bloomfield",
            "state": "CT",
            "country_code": "US",
            "postal_code": "060023088",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bloomfield, CT

Sources for this page

Verify at the official NPI Registry.