MHS Primary Care Inc
Organization Active NPI Family Medicine Physician · Moodus, CT
NPI 1811322951 · NPPES record last updated Jan 20, 2017
Key facts
- NPI
- 1811322951
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- MHS PRIMARY CARE INC
- Practice address
- 27 William F Palmer Rd
Moodus, CT 06469-1132 - Phone
- (860) 873-1414
- Fax
- (860) 358-8659
- NPI assigned
- Sep 9, 2013
- Organization subpart
- No
Authorized official
- Name
- Susan Serkey
- Title
- Network Executive
- Phone
- (860) 358-4802
Other NPIs on the same Medicare enrollment 12
Practitioners 3
-
Jennifer Freeman, APRN
-
Shane Thomas Ridge, D.O.
-
Michael Paul Spada, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 07D0096311 | MHS Primary Care Inc | Provider-performed microscopy | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040202000945 | CT | Part B Supplier - Clinic/Group Practice | 4082507371 |
Receives reassigned benefits from 218 practitioners 12 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Middletown, CT; Moodus, CT; New Haven, CT; Old Saybrook, CT; Portland, CT; Westbrook, CT; Marlborough, CT; Madison, CT… |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Internal Medicine Physician |
207R00000X | CT | ||
| Physician Assistant |
363A00000X | |||
| Family Nurse Practitioner |
363LF0000X |
Addresses
Primary practice location
27 William F Palmer Rd
Moodus, CT 06469-1132
Mailing address
28 Crescent St
Middletown, CT 06457-3654
Phone (860) 358-4820
Other providers in Moodus, CT
- Daniel A Henriquez
- Brittany Davis Klepac
- Nancy Anne Lavriha-Smith
- Andrew Lizotte
- Cheri Marks-Cavanna
- Mindful Therapy Studio LLC
- Matthew Morris-Wood
- Nicole Muckenhirn
- Keith J Murphey
- Nathan Hale Pharmacy Inc
All providers in Moodus, CT · Family Medicine Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 20, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.