NPIMap

Organization Active NPI

Connecticut Addiction Medicine, LLC

  • Addiction Psychiatry Physician
  • Rocky Hill, CT
National Provider Identifier
1710312368
Registry record updated Apr 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Psychiatry PhysicianTaxonomy code 2084P0802X
Legal business name
CONNECTICUT ADDICTION MEDICINE, LLC
Practice address
546 Cromwell Ave
Suite 101
Rocky Hill, CT 06067-1800
Phone
(860) 757-3874
Fax
(860) 757-3875
NPI assigned
Sep 13, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2017

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

Authorized official

Name
Tiffany Ingold, OFFICE MANAGER
Title
Office Manager
Phone
(860) 969-1101

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X
Addiction Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QA0401X
Addiction Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RA0401X
Addiction Medicine (Psychiatry & Neurology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084A0401X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X
Addiction Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0802X Primary
Clinical Medical Laboratory 291U00000X CLPOL0509 CT
Adult Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LA2200X CT
Psychiatric/Mental Health Clinical Nurse SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 364SP0808X

Addresses

Primary practice location

546 Cromwell Ave
Suite 101
Rocky Hill, CT 06067-1800

Mailing address

546 Cromwell Ave
Suite 101
Rocky Hill, CT 06067-1800
Phone (860) 757-3874

Other names 1

  • Connecticut Addiction Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140630000400 CT Part B Supplier - Clinic/Group Practice 3274758560 Receives reassigned benefits from 9 practitioners
Practice locations: Rocky Hill, CT
O20170801001482 CT Part B Supplier - Independent Clinical Laboratory 3274758560 Practice locations: Hartford, CT

National Provider Directory

National Provider Directory

Locations

330 Main St
Ste 101
Hartford, CT 06106
Phone (860) 969-1101

330 Main St
Fl 1
Hartford, CT 06106
Phone (860) 757-3874

546 Cromwell Ave
Ste 101
Rocky Hill, CT 06067
Phone (860) 757-3874

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1379030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492560000000",
    "number": "1710312368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "546 CROMWELL AVE",
            "address_2": "SUITE 101",
            "city": "ROCKY HILL",
            "state": "CT",
            "postal_code": "060671800",
            "telephone_number": "860-757-3874",
            "fax_number": "860-757-3875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "546 CROMWELL AVE",
            "address_2": "SUITE 101",
            "city": "ROCKY HILL",
            "state": "CT",
            "postal_code": "060671800",
            "telephone_number": "860-757-3874",
            "fax_number": "860-757-3875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNECTICUT ADDICTION MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-13",
        "last_updated": "2017-04-19",
        "status": "A",
        "authorized_official_last_name": "INGOLD",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "860-969-1101",
        "authorized_official_credential": "OFFICE MANAGER"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084A0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CT",
            "license": "CLPOL0509",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CT",
            "license": null,
            "primary": false
        },
        {
            "code": "364SP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Connecticut Addiction Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rocky Hill, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2017; 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.