NPIMap

Individual provider Active NPI

John Wenceslao, MD

  • Internal Medicine Physician
  • Bloomfield, CT
National Provider Identifier
1740203868
Registry record updated Jun 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
035462 Issued in CT
Practice address
701 Cottage Grove Rd Ste D110
Bloomfield, CT 06002-3085
Phone
(860) 530-2014
NPI assigned
Jul 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2021

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 035462 CT Primary

Addresses

Primary practice location

701 Cottage Grove Rd Ste D110
Bloomfield, CT 06002-3085

Mailing address

1000 Asylum Ave
Suite 3218
Hartford, CT 06105-1770
Phone (860) 714-5415

Other identifiers 3

IdentifierTypeStateIssuer
010035462CT01OtherCTANTHEM BLUE SHIELD
01354620MedicaidCT
0V4804OtherHEALTHNET

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jwenceslao16857@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
I20100511000163 CT Practitioner - Internal Medicine 9234267386 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Collins Medical Associates 2 PCGroup PAC ID 3779486345, 43 clinicians

Practice addresses (Care Compare)

701 Cottage Grove Rd
Suite D110
Bloomfield, CT 06002-3085
Phone (860) 714-5415

95 Woodland St
FL 1
Hartford, CT 06105-1230
Phone (860) 714-7362

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
035462CTMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Collins Medical Associates 2 PC Internal Medicine CurrentSince Jun 1, 1999 Accepting new patients
Intercommunity, Inc. CurrentSince Aug 20, 2018 Accepting new patients
Collins Medical Associates 2 PC Internal Medicine CurrentSince Jun 1, 1999 Accepting new patients
Intercommunity, Inc. Current Accepting new patients
Johnson Professional Associates, PC Internal Medicine Past Accepting new patients

Locations

701 Cottage Grove Rd
Ste D110
Bloomfield, CT 06002
Phone (860) 522-1101

699A Cottage Grove Rd
Bloomfield, CT 06002
Phone (860) 242-0034

281 Main St
East Hartford, CT 06118
Phone (860) 291-1335

95 Woodland St
Fl 1
Hartford, CT 06105
Phone (860) 714-7362

16 Coventry St
Hartford, CT 06112
Phone (860) 714-3701

1000 Asylum Ave
Ste 3218
Hartford, CT 06105
Phone (860) 714-5415

800 Connecticut Blvd
Fl 4
Hartford, CT 06108
Phone (860) 622-5451

Interoperability endpoints

  • Direct secure messaging: john.wenceslao.1@27673.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/27673/brand/1/csg/1/fhir/r4

Organizations & group practices 5

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.

Hospital & facility affiliations 9

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": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624233600000",
    "number": "1740203868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 ASYLUM AVE",
            "address_2": "SUITE 3218",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061051770",
            "telephone_number": "860-714-5415",
            "fax_number": "860-714-8861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 COTTAGE GROVE RD STE D110",
            "city": "BLOOMFIELD",
            "state": "CT",
            "postal_code": "060023085",
            "telephone_number": "860-530-2014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WENCESLAO",
        "first_name": "JOHN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2021-06-21",
        "certification_date": "2021-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "035462",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE SHIELD",
            "identifier": "010035462CT01",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01354620",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "0V4804",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jwenceslao16857@direct.stfranciscare.org",
            "affiliation": "N",
            "endpointDescription": "Saint Francis Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "701 Cottage Grove Rd Ste D110",
            "city": "Bloomfield",
            "state": "CT",
            "country_code": "US",
            "postal_code": "060023085",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bloomfield, CT

Sources for this page

Verify at the official NPI Registry.