Prime Healthcare Iod

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

Legal business name

PRIME HEALTHCARE IOD

Practice address

6 Northwestern Dr Ste 101
Bloomfield, CT 06002-3416

Phone

(860) 580-5656

Fax

(860) 580-5799

NPI assigned

May 30, 2025

Organization subpart

Yes

Parent organization

PRIME HEALTHCARE, PCAs reported in NPPES

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

Authorized official

Name

Serena Ann Kimball

Title

Director of Coding and Compliance

Phone

(860) 263-0256

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Prime Healthcare PC2 organizations share this tax ID, including this one

Part of

Prime Healthcare PC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Prime Healthcare (Sleep Lab)

  • Sleep Disorder Diagnostic Clinic/Center
  • Wethersfield, CT
  • NPI 1184832354
  NPD tax ID

Locations

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.

• Prime Healthcare, PC

  • Internal Medicine Physician
  • Wethersfield, CT
  • NPI 1184819302
  NPPES parent name

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

{
    "created_epoch": "1748563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748563200000",
    "number": "1710870696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 NORTHWESTERN DR STE 101",
            "city": "BLOOMFIELD",
            "state": "CT",
            "postal_code": "060023416",
            "telephone_number": "860-580-5656",
            "fax_number": "860-580-5799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 NORTHWESTERN DR STE 101",
            "city": "BLOOMFIELD",
            "state": "CT",
            "postal_code": "060023416",
            "telephone_number": "860-580-5656",
            "fax_number": "860-580-5799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME HEALTHCARE IOD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRIME HEALTHCARE, PC",
        "enumeration_date": "2025-05-30",
        "last_updated": "2025-05-30",
        "certification_date": "2025-05-30",
        "status": "A",
        "authorized_official_last_name": "KIMBALL",
        "authorized_official_first_name": "SERENA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "DIRECTOR OF CODING AND COMPLIANCE",
        "authorized_official_telephone_number": "860-263-0256"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Ann Powderly, LPC
• Murthappa N Prakash, MD
• Kenneth Pratt, LMSW
• Primary Eye Care Center, PC
• Primary Eye Care Center, PC
• Propicius Brain & Spine LLC
• Prosperity Homecare, Inc.
• Prosthetic & Orthotic Solutions, LLC.
• Todd Provost, PTA
• Psychological Health Associates LLC

• Non-Pharmacy Dispensing Site in Bloomfield, CT
• Providers in Bloomfield, CT by specialty
• Non-Pharmacy Dispensing Site in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.