Active NPI
Stephen Brenner, MD
- Internal Medicine Physician
- New Haven, CT
National Provider Identifier
1730188764
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 17408
- Practice address
- 129 York St
New Haven, CT 06511-5608 - Phone
- (203) 789-8888
- NPI assigned
- Jul 20, 2005
- Last updated
- Jan 24, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 17408 | CT | Primary |
Addresses
Primary practice location
129 York St
New Haven, CT 06511-5608
Mailing address
2989 Dixwell Ave
Hamden, CT 06518-3501
Phone (203) 248-3013
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1051333 | Other | CT | AETNA |
| 757491 | Other | CT | CONNECTICARE |
| NHP118 | Other | CT | OXFORD |
| 010017408CT03 | Other | CT | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17408 | CT | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Connecticut Medical Group, LLC | Internal Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Primary Care Nurse Practitioner
- Hamden, CT
- NPI 1366504227
Internal Medicine
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": "1358985600000",
"number": "1730188764",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2989 DIXWELL AVE",
"city": "HAMDEN",
"state": "CT",
"postal_code": "065183501",
"telephone_number": "203-248-3013",
"fax_number": "203-248-2878"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "129 YORK ST",
"city": "NEW HAVEN",
"state": "CT",
"postal_code": "065115608",
"telephone_number": "203-789-8888"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRENNER",
"first_name": "STEPHEN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-20",
"last_updated": "2013-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CT",
"license": "17408",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "1051333",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CONNECTICARE",
"identifier": "757491",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD",
"identifier": "NHP118",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "010017408CT03",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in New Haven, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.