Active NPI
Matthew John King
- Family Medicine Physician
- Groton, CT
National Provider Identifier
1821679697
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 078842
- Practice address
- 404 Thames St
Groton, CT 06340-3959 - Phone
- (860) 445-0494
- NPI assigned
- Apr 14, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Family Medicine Physician | 207Q00000X | 078842 | CT | Primary |
Addresses
Primary practice location
404 Thames St
Groton, CT 06340-3959
Mailing address
404 Thames St
Groton, CT 06340-3959
Phone (860) 445-0494
Other practice location 1
365 Montauk Ave
New London, CT 06320-4700
Phone (860) 442-0711
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- University of Texas Medical School at San Antonio, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Ptsma Inc
Practice addresses (Care Compare)
37 S Broad St
Pawcatuck, CT 06379-7909
Phone (860) 495-1919
404 Thames St
Groton, CT 06340-3959
Phone (860) 445-0494
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 078842 | CT | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northeast Medical Group, Inc. | Current | Accepting new patients |
Locations
365 Montauk Ave
New London, CT 06320
Phone (860) 271-4364
95 Armory Rd
Stratford, CT 06614
Phone (203) 384-3388
Interoperability endpoints
- mking679697@direct.ynhh.org
Organizations & group practices 1
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.
-
- Internal Medicine Physician
- Bridgeport, CT
- NPI 1043278351
Hospital & facility affiliations 7
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- New London, CT
- NPI 1073530879
-
- General Acute Care Hospital
- New London, CT
- NPI 1700092459
-
- Home Health Agency
- Wallingford, CT
- NPI 1710976220
-
- Home Health Agency
- Waterford, CT
- NPI 1265490940
-
- General Acute Care Hospital
- New Haven, CT
- NPI 1336139500
-
- General Acute Care Hospital
- New Haven, CT
- NPI 1578778726
-
- General Acute Care Hospital
- Westerly, RI
- NPI 1447595368
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1618358400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1720396800000",
"number": "1821679697",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "404 THAMES ST",
"city": "GROTON",
"state": "CT",
"postal_code": "063403959",
"telephone_number": "860-445-0494",
"fax_number": "860-865-2383"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "404 THAMES ST",
"city": "GROTON",
"state": "CT",
"postal_code": "063403959",
"telephone_number": "860-445-0494"
}
],
"practiceLocations": [
{
"address_1": "365 Montauk Ave",
"address_purpose": "LOCATION",
"city": "New London",
"state": "CT",
"postal_code": "063204700",
"country_code": "US",
"telephone_number": "860-442-0711",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KING",
"first_name": "MATTHEW",
"middle_name": "JOHN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-04-14",
"last_updated": "2024-07-08",
"certification_date": "2024-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CT",
"license": "078842",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Groton, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.