NPIMap

Organization Active NPI

Progressive Institute LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Shelton, CT
National Provider Identifier
1669944724
Registry record updated Sep 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
PROGRESSIVE INSTITUTE LLC
Practice address
2 Trap Falls Rd Ste 120
Shelton, CT 06484-4616
Phone
(203) 816-6424
Fax
(630) 522-0843
NPI assigned
Dec 28, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2020

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

Authorized official

Name
Greg Gillam
Title
Director of Operations
Phone
(203) 816-6424

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

2 Trap Falls Rd Ste 120
Shelton, CT 06484-4616

Mailing address

2 Trap Falls Rd Ste 120
Shelton, CT 06484-4616
Phone (203) 816-6424

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190403000063 CT Part B Supplier - Clinic/Group Practice 6305187238 Receives reassigned benefits from 3 practitioners
Practice locations: Shelton, CT

National Provider Directory

National Provider Directory

Locations

2 Trap Falls Rd
Ste 120
Shelton, CT 06484
Phone (203) 641-6090

35 Nutmeg Dr
Ste 301
Trumbull, CT 06611

Practitioners & affiliated clinicians

Practitioners 8

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

NPI Registry JSON

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

{
    "created_epoch": "1545955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599523200000",
    "number": "1669944724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 TRAP FALLS RD STE 120",
            "city": "SHELTON",
            "state": "CT",
            "postal_code": "064844616",
            "telephone_number": "203-816-6424",
            "fax_number": "203-513-8474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 TRAP FALLS RD STE 120",
            "city": "SHELTON",
            "state": "CT",
            "postal_code": "064844616",
            "telephone_number": "203-816-6424",
            "fax_number": "630-522-0843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROGRESSIVE INSTITUTE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-28",
        "last_updated": "2020-09-08",
        "certification_date": "2020-09-08",
        "status": "A",
        "authorized_official_last_name": "GILLAM",
        "authorized_official_first_name": "GREG",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "203-816-6424"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelton, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2020; 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.