Individual provider Active NPI

Andrew Carlson, M.D.

  • Pediatrics Physician
  • Orange, CT
National Provider Identifier
1811006802
Registry record updated Sep 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
039862 Issued in CT
Practice address
240 Indian River Rd
Suite B-1
Orange, CT 06477-3649
Phone
(203) 795-4924
Fax
(203) 799-1554
NPI assigned
Aug 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 039862 CT Primary

Addresses

Primary practice location

240 Indian River Rd
Suite B-1
Orange, CT 06477-3649

Mailing address

240 Indian River Rd
Suite B-1
Orange, CT 06477-3649
Phone (203) 795-4924

Other practice location 1

282 Washington St
Hartford, CT 06106-3322
Phone (860) 837-7250

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address acarlson46475@connecticutchildrens.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190626002888 CT Practitioner - Pediatric Medicine 0143553701 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
039862CTMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Connecticut Children'S Specialty Group, Inc. Pediatrics CurrentSince May 15, 2019 Accepting new patients
Connecticut Children'S Specialty Group, Inc. Pediatrics CurrentSince May 15, 2019 Accepting new patients
Pediatrics and Adolescent Medicine, P.C. Pediatrics Past Accepting new patients

Locations

800 Connecticut Blvd
Fl 1
East Hartford, CT 06108
Phone (800) 535-6232

599 Farmington Ave
Ste 202
Farmington, CT 06032
Phone (860) 837-5170

10 Columbus Blvd
Ste 403
Hartford, CT 06106
Phone (860) 837-7250

282 Washington St
Hartford, CT 06106
Phone (860) 545-8950

10 Columbus Blvd
Hartford, CT 06106
Phone (860) 837-5619

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662681600000",
    "number": "1811006802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 INDIAN RIVER RD",
            "address_2": "SUITE B-1",
            "city": "ORANGE",
            "state": "CT",
            "postal_code": "064773649",
            "telephone_number": "203-795-4924",
            "fax_number": "203-799-1554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 INDIAN RIVER RD",
            "address_2": "SUITE B-1",
            "city": "ORANGE",
            "state": "CT",
            "postal_code": "064773649",
            "telephone_number": "203-795-4924",
            "fax_number": "203-799-1554"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "282 Washington St",
            "address_purpose": "LOCATION",
            "city": "Hartford",
            "state": "CT",
            "postal_code": "061063322",
            "country_code": "US",
            "telephone_number": "860-837-7250",
            "fax_number": "860-837-6970",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "ANDREW",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2022-09-09",
        "certification_date": "2022-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CT",
            "license": "039862",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "acarlson46475@connecticutchildrens.direct-ci.com",
            "affiliation": "N",
            "address_1": "282 Washington St",
            "city": "Hartford",
            "state": "CT",
            "country_code": "US",
            "postal_code": "061063322",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Orange, CT

Sources for this page

Verify at the official NPI Registry.