NPIMap

Individual provider Active NPI

Marc D. Eisen, M.D.

  • Otology & Neurotology Physician
  • Farmington, CT
National Provider Identifier
1649345513
Registry record updated Nov 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otology & Neurotology PhysicianTaxonomy code 207YX0901X
License
045054 Issued in CT
Practice address
40 Stanford Dr
Farmington, CT 06032-2454
Phone
(860) 640-4455
Fax
(860) 640-4478
NPI assigned
Nov 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otology & Neurotology Physician 207YX0901X 045054 CT Primary

Addresses

Primary practice location

40 Stanford Dr
Farmington, CT 06032-2454

Mailing address

40 Stanford Dr
Farmington, CT 06032-2454
Phone (860) 640-4455

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
I20070213000559 CT Practitioner - OtolaryngologyPractitioner - Other (Physician) 9537161039 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Perelman School of Med at the University of Pennsylvania, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ear Specialty Group of Connecticut PCGroup PAC ID 0446502686, 7 clinicians
Hartford HospitalGroup PAC ID 2567366016, shared by 6 NPIs, 1,040 clinicians

Practice addresses (Care Compare)

40 Stanford Dr
Farmington, CT 06032-2454
Phone (860) 640-4455

80 Seymour St
Hartford, CT 06102-8000

Hospital & facility affiliations

  • Hartford Hospital Hospital, Hartford, CT, CCN 070025
  • William W Backus Hospital Hospital, Norwich, CT, CCN 070024
  • The Hospital of Central Connecticut Hospital, New Britain, CT, CCN 070035
  • Charlotte Hungerford Hospital Hospital, Torrington, CT, CCN 070011

Merit-based Incentive Payment System (MIPS)

Final score
90.52 of 100Reported as group
Quality
91.59
Promoting interoperability
100
Improvement activities
40
Cost
73.34

Merit-based Incentive Payment System (MIPS)

Final score
92.63 of 100Reported as group
Quality
75.35
Promoting interoperability
100
Improvement activities
40
Cost
71.44

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
045054CTMDOtology & Neurotology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hartford Hospital CurrentSince Jan 15, 2008 Accepting new patients
Hartford Hospital CurrentSince Jan 15, 2008 Accepting new patients
Ear Specialty Group of Connecticut PC Otology & Neurotology CurrentSince Dec 1, 2018 Accepting new patients
Hartford Hospital CurrentSince Nov 1, 2008 Accepting new patients

Locations

40 Stanford Dr
Farmington, CT 06032
Phone (860) 640-4455

85 Seymour St
Ste 318
Hartford, CT 06106
Phone (860) 493-1950

65 Memorial Rd
Ste 200
West Hartford, CT 06107
Phone (860) 640-4455

Organizations & group practices 4

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": "1164240000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699574400000",
    "number": "1649345513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 STANFORD DR",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060322454",
            "telephone_number": "860-640-4455",
            "fax_number": "860-640-4478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 STANFORD DR",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060322454",
            "telephone_number": "860-640-4455",
            "fax_number": "860-640-4478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EISEN",
        "first_name": "MARC",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-23",
        "last_updated": "2023-11-10",
        "certification_date": "2023-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0901X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otology & Neurotology",
            "state": "CT",
            "license": "045054",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, CT

Sources for this page

Verify at the official NPI Registry.