MHS Primary Care
Organization Active NPI Family Medicine Physician · Portland, CT
NPI 1710104625 · NPPES record last updated Sep 8, 2017
Key facts
- NPI
- 1710104625
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- MHS PRIMARY CARE
- Practice address
- 270 Main St
Portland, CT 06480-1857 - Phone
- (860) 342-3392
- Fax
- (860) 358-8658
- NPI assigned
- Apr 20, 2007
- Organization subpart
- No
Authorized official
- Name
- Ms. Susan Serkey
- Title
- Practice Administrator
- Phone
- (860) 358-4802
Other NPIs on the same Medicare enrollment 12
Corporate family (same tax ID) 16
Practitioners 5
-
Justin Caskey, DO
-
Israel Cordero, MD
-
Kristin Holahan, PA-C
-
Nicholas R. Klock, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040202000945 | CT | Part B Supplier - Clinic/Group Practice | 4082507371 |
Receives reassigned benefits from 218 practitioners 12 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Middletown, CT; Moodus, CT; New Haven, CT; Old Saybrook, CT; Portland, CT; Westbrook, CT; Marlborough, CT; Madison, CT… |
National Provider Directory
- Tax ID family
- MHS Primary Care Inc
Locations
270 Main St
Portland, CT 06480
Phone (860) 342-3392
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker |
1041C0700X | |||
| Family Medicine Physician |
207Q00000X | Yes | ||
| Internal Medicine Physician |
207R00000X | CT | ||
| Physician Assistant |
363A00000X | |||
| Family Nurse Practitioner |
363LF0000X |
Addresses
Primary practice location
270 Main St
Portland, CT 06480-1857
Mailing address
28 Crescent St
Middletown, CT 06457-3654
Phone (860) 358-4819
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04173259 | Medicaid | CT |
Other names
- George Rosenfeld, MD
Other providers in Portland, CT
- Life Family Chiropractic of Portland, LLC
- Lori Orend, LCSW LLC
- Robert R. Malafronte
- Timothy Malton
- Micaela Mellow
- Middlesex Hospital Dba Family Practice Group Portland
- Jaime Morales
- Tracy Santos Morales
- Kristen Coffey Moran-Dillon
- John Louis Mormile
All providers in Portland, CT · Family Medicine Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 8, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.