NPIMap

Organization Active NPI

Saint Francis Care Medical Group, P.C.

  • Family Medicine Physician
  • Hartford, CT
National Provider Identifier
1760690101
Registry record updated Mar 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SAINT FRANCIS CARE MEDICAL GROUP, P.C.
Practice address
114 Woodland St
Saint Francis Care Medical Group PC
Hartford, CT 06105-1208
Phone
(860) 979-1880
NPI assigned
May 18, 2007
Organization subpart
Yes
Parent organization
SAINT FRANCIS CARE, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 11, 2016

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

Authorized official

Name
Surendra Khera, MD
Title
Chief Medical Officer
Phone
(860) 714-4361

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ZP0102X CT

Addresses

Primary practice location

114 Woodland St
Saint Francis Care Medical Group PC
Hartford, CT 06105-1208

Mailing address

1000 Asylum Ave
Suite 4309
Hartford, CT 06105-1770
Phone (860) 714-1325

Other identifiers 4

IdentifierTypeStateIssuer
004211215MedicaidCT
8413924000MedicaidCT
004156437MedicaidCT
008025819MedicaidCT

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040130000318 CT Part B Supplier - Clinic/Group Practice 3274436845 Receives reassigned benefits from 25 practitioners
1 other NPI on this enrollment
Practice locations: Hartford, CT; Stafford Springs, CT; Waterbury, CT

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Burgdorf Bank of America Health Center

Locations

1000 Asylum Ave
Ste 21094
Hartford, CT 06105

Practitioners & affiliated clinicians

Practitioners 28

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

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457654400000",
    "number": "1760690101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 ASYLUM AVE",
            "address_2": "SUITE 4309",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061051770",
            "telephone_number": "860-714-1325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 WOODLAND ST",
            "address_2": "SAINT FRANCIS CARE MEDICAL GROUP PC",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061051208",
            "telephone_number": "860-979-1880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAINT FRANCIS CARE MEDICAL GROUP, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAINT FRANCIS CARE, INC",
        "enumeration_date": "2007-05-18",
        "last_updated": "2016-03-11",
        "status": "A",
        "authorized_official_last_name": "KHERA",
        "authorized_official_first_name": "SURENDRA",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "860-714-4361",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CT",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004211215",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8413924000",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004156437",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008025819",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hartford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2016; 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.