NPIMap

Organization Active NPI

Integrated Wound Care Connecticut PLLC

  • General Practice Physician
  • Southport, CT
National Provider Identifier
1649778762
Registry record updated Mar 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
INTEGRATED WOUND CARE CONNECTICUT PLLC
Practice address
930 Mill Hill Ter
Southport, CT 06890-1265
Phone
(718) 705-6010
NPI assigned
Jan 23, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2018

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

Authorized official

Name
Michael M Ginsburg
Title
President
Phone
(718) 963-3495

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

930 Mill Hill Ter
Southport, CT 06890-1265

Mailing address

492C Cedar LN Ste 514
Teaneck, NJ 07666-1713

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180315000678 CT Part B Supplier - Clinic/Group Practice 0042572893 Receives reassigned benefits from 14 practitioners
Practice locations: Southport, CT

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1516665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521072000000",
    "number": "1649778762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "492C CEDAR LN STE 514",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076661713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 MILL HILL TER",
            "city": "SOUTHPORT",
            "state": "CT",
            "postal_code": "068901265",
            "telephone_number": "718-705-6010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED WOUND CARE CONNECTICUT PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-23",
        "last_updated": "2018-03-15",
        "status": "A",
        "authorized_official_last_name": "GINSBURG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-963-3495"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southport, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.