Individual provider Active NPI

David M Sack, MD

  • Gastroenterology Physician
  • Manchester, NH
National Provider Identifier
1710986898
Registry record updated Oct 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
EL10071 Issued in NH
Practice address
100 Hitchcock Way
Manchester, NH 03104-4125
Phone
(603) 695-2500
NPI assigned
Jul 20, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 027392 CT
Gastroenterology Physician 207RG0100X EL10071 NH Primary

Addresses

Primary practice location

100 Hitchcock Way
Manchester, NH 03104-4125

Mailing address

PO Box 810
Hanover, NH 03755-0810
Phone (603) 308-1467

Other practice location 1

455 Lewis Ave
Suite 105
Meriden, CT 06451-2121
Phone (203) 237-2477

Other identifiers 1

IdentifierTypeStateIssuer
1273929MedicaidCT

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080710000042 CT Practitioner - GastroenterologyPractitioner - Internal Medicine 3779476718 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
EL10071NHMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Connecticut Gi PLLC Gastroenterology CurrentSince Mar 1, 2015 Accepting new patients
United Community and Family Services, Inc. CurrentSince Jul 1, 2020 Accepting new patients
Midstate Gastroenterology Specialists PC Gastroenterology Past Accepting new patients
Midstate Medical Group, PC Past Accepting new patients

Locations

85 Seymour St
Ste 1000
Hartford, CT 06106
Phone (860) 246-2571

70 Main St
Jewett City, CT 06351
Phone (860) 376-7040

455 Lewis Ave
Ste 200
Meriden, CT 06451
Phone (203) 238-9446

47 Town St
Norwich, CT 06360

30 Waterchase Dr
Rocky Hill, CT 06067
Phone (860) 257-4131

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1121817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664755200000",
    "number": "1710986898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 810",
            "city": "HANOVER",
            "state": "NH",
            "postal_code": "037550810",
            "telephone_number": "603-308-1467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HITCHCOCK WAY",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031044125",
            "telephone_number": "603-695-2500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "455 Lewis Ave",
            "address_2": "Suite 105",
            "address_purpose": "LOCATION",
            "city": "Meriden",
            "state": "CT",
            "postal_code": "064512121",
            "country_code": "US",
            "telephone_number": "203-237-2477",
            "fax_number": "203-238-1839",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SACK",
        "first_name": "DAVID",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-20",
        "last_updated": "2022-10-03",
        "certification_date": "2022-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "CT",
            "license": "027392",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NH",
            "license": "EL10071",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1273929",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, NH

Sources for this page

Verify at the official NPI Registry.