Active NPI
Jesse M. Chua-Reyes, M.D.
- Geriatric Medicine (Internal Medicine) Physician
- New Haven, CT
National Provider Identifier
1669473724
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Medicine (Internal Medicine) Physician
- License
- 035500
- Practice address
- 874 Howard Ave
New Haven, CT 06519-1106 - Phone
- (203) 688-8200
- Fax
- (203) 688-8204
- NPI assigned
- Aug 10, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Medicine (Internal Medicine) Physician | 207RG0300X | 035500 | CT | Primary |
Addresses
Primary practice location
874 Howard Ave
New Haven, CT 06519-1106
Mailing address
874 Howard Ave
New Haven, CT 06519-1106
Phone (203) 688-8200
Other identifiers 11
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001355008 | Medicaid | CT | |
| P00053271 | Other | CT | RAIL ROAD MEDICARE |
| 061561581 | Other | CT | HEALTH CT |
| 0Q2710 | Other | CT | HEALTH NET |
| P2932518 | Other | CT | OXFORD |
| 061561581 | Other | CT | UNITED HEALTHCARE |
| 3385240 | Other | CT | AETNA |
| 355508 | Other | CT | WELLCARE OF CT |
| 010035500CT01 | Other | CT | ANTHEM BC/BS |
| 061561581 | Other | CT | CIGNA |
| 758106 | Other | CT | CONNECTICARE |
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 035500 | CT | MD | Geriatric Medicine (Internal Medicine) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CS Pacs 3 Northeast, LLC | Current | Accepting new patients | |
| Connecticut Post Acute Medical Services 1 PC | Current | Accepting new patients | |
| Ma Pacs 2 PC | Current | Accepting new patients | |
| Masonicare Behavioral Health, LLC | Past | Accepting new patients |
Locations
111 Church St
Middletown, CT 06457
Phone (860) 347-3786
31 Vauxhall St
New London, CT 06320
Phone (203) 789-1650
88 Clark Ln
Waterford, CT 06385
Phone (860) 442-0471
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.
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- Geriatric Psychiatry Physician
- Wallingford, CT
- NPI 1992781488
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1231459200000",
"number": "1669473724",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "874 HOWARD AVE",
"city": "NEW HAVEN",
"state": "CT",
"postal_code": "065191106",
"telephone_number": "203-688-8200",
"fax_number": "203-688-8204"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "874 HOWARD AVE",
"city": "NEW HAVEN",
"state": "CT",
"postal_code": "065191106",
"telephone_number": "203-688-8200",
"fax_number": "203-688-8204"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHUA-REYES",
"first_name": "JESSE",
"middle_name": "M.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-10",
"last_updated": "2009-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Geriatric Medicine",
"state": "CT",
"license": "035500",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001355008",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAIL ROAD MEDICARE",
"identifier": "P00053271",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH CT",
"identifier": "061561581",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH NET",
"identifier": "0Q2710",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD",
"identifier": "P2932518",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "061561581",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "3385240",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLCARE OF CT",
"identifier": "355508",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BC/BS",
"identifier": "010035500CT01",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "061561581",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CONNECTICARE",
"identifier": "758106",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}
Other providers in New Haven, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.