Active NPI
Internal Medicine Group LLC
- Geriatric Medicine (Internal Medicine) Physician
- Norwich, CT
National Provider Identifier
1770617367
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Medicine (Internal Medicine) Physician
- License
- 037461
- Legal business name
- INTERNAL MEDICINE GROUP LLC
- Practice address
- 1 Towne Park PLZ
Norwich, CT 06360-2247 - Phone
- (860) 887-0010
- Fax
- (860) 887-0178
- NPI assigned
- Mar 15, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Hanna Kackielo, MD
- Title
- Owner
- Phone
- (860) 887-0010
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Medicine (Internal Medicine) Physician | 207RG0300X | 037461 | CT | Primary |
Addresses
Primary practice location
1 Towne Park PLZ
Norwich, CT 06360-2247
Mailing address
1 Towne Park PLZ
Norwich, CT 06360-2247
Phone (860) 887-0010
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040615001607 | CT | Part B Supplier - Clinic/Group Practice | 6204810401 |
Receives reassigned benefits from 5 practitioners Practice locations: Norwich, CT |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 5
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": "1173916800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1770617367",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 TOWNE PARK PLZ",
"city": "NORWICH",
"state": "CT",
"postal_code": "063602247",
"telephone_number": "860-887-0010",
"fax_number": "860-887-0178"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 TOWNE PARK PLZ",
"city": "NORWICH",
"state": "CT",
"postal_code": "063602247",
"telephone_number": "860-887-0010",
"fax_number": "860-887-0178"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "INTERNAL MEDICINE GROUP LLC",
"organizational_subpart": "NO",
"enumeration_date": "2007-03-15",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "KACKIELO",
"authorized_official_first_name": "HANNA",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "860-887-0010",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207RG0300X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine, Geriatric Medicine",
"state": "CT",
"license": "037461",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Norwich, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.