NPIMap

Organization Active NPI

Meditox Care, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Westport, CT
National Provider Identifier
1730623737
Registry record updated Aug 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
MEDITOX CARE, LLC
Practice address
179 Post Rd W
Westport, CT 06880-4602
Phone
(203) 450-4882
Fax
(866) 505-8927
NPI assigned
Dec 9, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2022

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

Authorized official

Name
Mohamed Elsamra, MDNPI 1457464406
Title
Owner and Manager
Phone
(203) 450-4882

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0802X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

179 Post Rd W
Westport, CT 06880-4602

Mailing address

179 Post Rd W
Westport, CT 06880-4602
Phone (203) 450-4882

Other names 1

  • Elevate Health and Wellness Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240314000324 CT Part B Supplier - Clinic/Group Practice 9830535723 Receives reassigned benefits from 6 practitioners
Practice locations: Westport, CT

National Provider Directory

National Provider Directory
Tax ID family
Meditox Care LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

53 Riverside Ave
Westport, CT 06880
Phone (203) 347-2484

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1481241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659484800000",
    "number": "1730623737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "179 POST RD W",
            "city": "WESTPORT",
            "state": "CT",
            "postal_code": "068804602",
            "telephone_number": "203-450-4882",
            "fax_number": "866-505-8927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "179 POST RD W",
            "city": "WESTPORT",
            "state": "CT",
            "postal_code": "068804602",
            "telephone_number": "203-450-4882",
            "fax_number": "866-505-8927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDITOX CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-09",
        "last_updated": "2022-08-03",
        "certification_date": "2022-08-03",
        "status": "A",
        "authorized_official_last_name": "ELSAMRA",
        "authorized_official_first_name": "MOHAMED",
        "authorized_official_title_or_position": "OWNER AND MANAGER",
        "authorized_official_telephone_number": "203-450-4882",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elevate Health and Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Westport, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2022; 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.