Active NPI
West Haven Medical Group, LLC
- Nurse Practitioner
- West Haven, CT
National Provider Identifier
1669623484
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- Legal business name
- WEST HAVEN MEDICAL GROUP, LLC
- Practice address
- 687 Campbell Ave
West Haven, CT 06516-3774 - Phone
- (203) 932-6481
- Fax
- (203) 932-4051
- NPI assigned
- Oct 10, 2008
- Organization subpart
- Yes
- Parent organization
- WEST HAVEN MEDICAL GROUP, LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Benedict L Fernando, M.D.
- Title
- Managing Partner
- Phone
- (203) 932-6481
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | Primary |
Addresses
Primary practice location
687 Campbell Ave
West Haven, CT 06516-3774
Mailing address
687 Campbell Ave
West Haven, CT 06516-3774
Phone (203) 932-6481
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004250833 | Medicaid | CT |
National Provider Directory
National Provider Directory- Tax ID family
- West Haven Medical Group LLC
- Part of
- West Haven Medical Group LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Physical Medicine & Rehabilitation Physician
- West Haven, CT
- NPI 1538498902
Ownership & related parties
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.
-
- Internal Medicine Physician
- West Haven, CT
- NPI 1417955923
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1223596800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1223596800000",
"number": "1669623484",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "687 CAMPBELL AVE",
"city": "WEST HAVEN",
"state": "CT",
"postal_code": "065163774",
"telephone_number": "203-932-6481",
"fax_number": "203-932-4051"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "687 CAMPBELL AVE",
"city": "WEST HAVEN",
"state": "CT",
"postal_code": "065163774",
"telephone_number": "203-932-6481",
"fax_number": "203-932-4051"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WEST HAVEN MEDICAL GROUP, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "WEST HAVEN MEDICAL GROUP, LLC",
"enumeration_date": "2008-10-10",
"last_updated": "2008-10-10",
"status": "A",
"authorized_official_last_name": "FERNANDO",
"authorized_official_first_name": "BENEDICT",
"authorized_official_middle_name": "L",
"authorized_official_title_or_position": "MANAGING PARTNER",
"authorized_official_telephone_number": "203-932-6481",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004250833",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Haven, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.