NPIMap

Organization Active NPI

Connecticut Pathology Group PC

  • Anatomic Pathology & Clinical Pathology Physician
  • Middletown, CT
National Provider Identifier
1740219625
Registry record updated Aug 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
016547 Issued in CT
Legal business name
CONNECTICUT PATHOLOGY GROUP PC
Practice address
28 Crescent St
Middletown, CT 06457-3654
Phone
(860) 344-6174
Fax
(860) 344-6062
NPI assigned
Jul 2, 2006
Last updated
Aug 17, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2018

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

Authorized official

Name
Dr. Jonathan Levine, MDNPI 1649200064
Title
Chief
Phone
(860) 344-6174

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 016547 CT Primary

Addresses

Primary practice location

28 Crescent St
Middletown, CT 06457-3654

Mailing address

PO Box 1590
New Haven, CT 06506-1590
Phone (203) 397-8000

Other identifiers 5

IdentifierTypeStateIssuer
4832OtherCTCONNECTICARE GROUP#
0039758OtherCTAETNA/USHC GRP#
4053021MedicaidCT
0077315OtherCTCIGNA GRP#
500HBL066CT01OtherCTBCBS GROUP#

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080722000230 CT Part B Supplier - Clinic/Group Practice 2769555978 Receives reassigned benefits from 4 practitioners
Practice locations: Middletown, CT

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
07D2279838Connecticut Pathology Group28 Crescent St, RM Eg074, Middletown, CT 06457ComplianceOct 18, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 188

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 188

NPI Registry JSON

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

{
    "created_epoch": "1151798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534464000000",
    "number": "1740219625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1590",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065061590",
            "telephone_number": "203-397-8000",
            "fax_number": "203-389-1540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 CRESCENT ST",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064573654",
            "telephone_number": "860-344-6174",
            "fax_number": "860-344-6062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNECTICUT PATHOLOGY GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-02",
        "last_updated": "2018-08-17",
        "status": "A",
        "authorized_official_last_name": "LEVINE",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "CHIEF",
        "authorized_official_telephone_number": "860-344-6174",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CT",
            "license": "016547",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONNECTICARE GROUP#",
            "identifier": "4832",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA/USHC GRP#",
            "identifier": "0039758",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4053021",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA GRP#",
            "identifier": "0077315",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP#",
            "identifier": "500HBL066CT01",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Middletown, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.