Innova Medical Group LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

INNOVA MEDICAL GROUP LLC

Practice address

669 Boston Post Rd Ste 8
Guilford, CT 06437-2739

Phone

(833) 446-6682

NPI assigned

Mar 20, 2023

Organization subpart

Yes

Parent organization

INNOVA-SG CORPAs reported in NPPES

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

Authorized official

Name

Michael PeckNPI 1386364206

Title

President

Phone

(617) 515-3970

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Innova-SG Corp

  • Durable Medical Equipment & Medical Supplies
  • Guilford, CT
  • NPI 1902035058
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael John Peck II

  • Orthotic Fitter
  • Guilford, CT
  • NPI 1386364206
  NPD Authorized official

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

{
    "created_epoch": "1679270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679270400000",
    "number": "1659073120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "669 BOSTON POST RD STE 8",
            "city": "GUILFORD",
            "state": "CT",
            "postal_code": "064372739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "669 BOSTON POST RD STE 8",
            "city": "GUILFORD",
            "state": "CT",
            "postal_code": "064372739",
            "telephone_number": "833-446-6682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVA MEDICAL GROUP LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INNOVA-SG CORP",
        "enumeration_date": "2023-03-20",
        "last_updated": "2023-03-20",
        "certification_date": "2023-03-20",
        "status": "A",
        "authorized_official_last_name": "PECK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "617-515-3970"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zahraa K Ibrahem, MD, MBA
• Isabel Marie Ignoto, OTR/L
• Jennifer E Igo Coogan, M.S. CCC-SLP
• Anna Imperiale
• Jodi E. Indes, M.D.
• Innova-SG Corp
• Integrative Physical Therapy, LLC
• Internal Medicine of Guilford LLC
• Steven Jacob, D.O.M., L. AC.
• Carolyn Jagielski, PT

• Durable Medical Equipment & Medical Supplies in Guilford, CT
• Providers in Guilford, CT by specialty
• Durable Medical Equipment & Medical Supplies in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2023; 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.