NPIMap

Organization Active NPI

Prospect Manchester Hospital, Inc.

  • Health Educator
  • South Windsor, CT
National Provider Identifier
1821695222
Registry record updated Oct 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health EducatorTaxonomy code 174H00000X
Legal business name
PROSPECT MANCHESTER HOSPITAL, INC.
Practice address
2800 Tamarack Ave Ste 100
South Windsor, CT 06074-5553
Phone
(860) 647-6824
NPI assigned
Oct 8, 2020
Last updated
Oct 8, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2020

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

Authorized official

Name
Robert Jon Elders
Title
Secretary
Phone
(714) 788-1249

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Educator 174H00000X NU Primary

Addresses

Primary practice location

2800 Tamarack Ave Ste 100
South Windsor, CT 06074-5553

Mailing address

2800 Tamarack Ave Ste 100
South Windsor, CT 06074-5553
Phone (860) 647-6824

Other names 1

  • ECHN Diabetes Wellness Center Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210601001702 CT MDPP Supplier - in-Person MDPP Supplier 9234423625 Practice locations: Manchester, CT

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Prospect Manchester Hospital Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1707 Boston Tpke
Coventry, CT 06238
Phone (860) 742-6792

150 N Main St
Manchester, CT 06042
Phone (860) 533-3434

360 Tolland Tpke
Manchester, CT 06042
Phone (860) 533-6551

2400 Tamarack Ave
Ste 101
South Windsor, CT 06074
Phone (860) 533-4693

2600 Tamarack Ave
South Windsor, CT 06074
Phone (860) 872-0501

2800 Tamarack Ave
Ste 100
South Windsor, CT 06074
Phone (860) 533-4692

2800 Tamarack Ave
Ste 101
South Windsor, CT 06074
Phone (860) 533-4670

Practitioners & affiliated clinicians

Practitioners 127

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 127

NPI Registry JSON

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

{
    "created_epoch": "1602115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602115200000",
    "number": "1821695222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 TAMARACK AVE STE 100",
            "city": "SOUTH WINDSOR",
            "state": "CT",
            "postal_code": "060745553",
            "telephone_number": "860-647-6824"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 TAMARACK AVE STE 100",
            "city": "SOUTH WINDSOR",
            "state": "CT",
            "postal_code": "060745553",
            "telephone_number": "860-647-6824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROSPECT MANCHESTER HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-08",
        "last_updated": "2020-10-08",
        "certification_date": "2020-10-08",
        "status": "A",
        "authorized_official_last_name": "ELDERS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "JON",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "714-788-1249"
    },
    "taxonomies": [
        {
            "code": "174H00000X",
            "taxonomy_group": "",
            "desc": "Health Educator",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ECHN Diabetes Wellness Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in South Windsor, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 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.

Verify at the official NPI Registry.