NPIMap

Individual provider Active NPI

George Donahue, MD

  • Internal Medicine Physician
  • Enfield, CT
National Provider Identifier
1710964325
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
018114 Issued in CT
Practice address
150 Hazard Ave
Enfield, CT 06082-4575
Phone
(860) 763-1043
Fax
(860) 749-1459
NPI assigned
Dec 23, 2005
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 018114 CT Primary

Addresses

Primary practice location

150 Hazard Ave
Enfield, CT 06082-4575

Mailing address

30 Jordan LN
Wethersfield, CT 06109-1278
Phone (860) 263-0253

Other identifiers 3

IdentifierTypeStateIssuer
01008114CT01OtherCTBCBS
001181148MedicaidCT
018114OtherCTMEDICAL LICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address gdonahue16894@direct.stfranciscare.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091209000473 CT Practitioner - Internal Medicine 1254420011 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
George Washington University School of Medicine, 1974
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Prime Healthcare, PCGroup PAC ID 6709787930, 67 clinicians

Practice addresses (Care Compare)

150 Hazard Ave
Suite C8
Enfield, CT 06082-4587
Phone (860) 763-1043

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
018114CTMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prime Healthcare, PC Internal Medicine CurrentSince Jan 1, 1998 Accepting new patients
Prime Healthcare (Sleep Lab) CurrentSince Jan 1, 1998 Accepting new patients

Locations

150 Hazard Ave
Enfield, CT 06082
Phone (860) 749-0791

150 Hazard Ave
Ste C8
Enfield, CT 06082
Phone (860) 763-1043

30 Jordan Ln
Wethersfield, CT 06109
Phone (860) 263-0253

Interoperability endpoints

  • Direct secure messaging: george.donahue.1@31712.direct.athenahealth.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Bickford Health Care CenterWindsor Locks, CT, CCN 075358 Skilled nursing facility Operational/Managerial Control Jan 1, 2021

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1135296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1710964325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 JORDAN LN",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061091278",
            "telephone_number": "860-263-0253",
            "fax_number": "860-263-0262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 HAZARD AVE",
            "city": "ENFIELD",
            "state": "CT",
            "postal_code": "060824575",
            "telephone_number": "860-763-1043",
            "fax_number": "860-749-1459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONAHUE",
        "first_name": "GEORGE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-23",
        "last_updated": "2023-03-07",
        "certification_date": "2021-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "018114",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "01008114CT01",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001181148",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "018114",
            "state": "CT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gdonahue16894@direct.stfranciscare.org",
            "affiliation": "N",
            "endpointDescription": "Prime Healthcare Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "150 Hazard Ave",
            "city": "Enfield",
            "state": "CT",
            "country_code": "US",
            "postal_code": "060824575",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Enfield, CT

Sources for this page

Verify at the official NPI Registry.