NPIMap

Organization Active NPI

Shoreline Orthopedics & Sports Medicine, LLC

  • Orthopaedic Surgery Physician
  • Essex, CT
National Provider Identifier
1861425597
Registry record updated Dec 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
SHORELINE ORTHOPEDICS & SPORTS MEDICINE, LLC
Practice address
12 Bokum Rd
Essex, CT 06426-1500
Phone
(860) 767-9053
Fax
(860) 767-1146
NPI assigned
Jul 8, 2006
Last updated
Dec 8, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2011

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

Authorized official

Name
Martin Jeffrey White, M.D.NPI 1699723742
Title
Physician Partner
Phone
(860) 767-9053

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 027273 CT
Orthopaedic Surgery Physician 207X00000X NU Primary

Addresses

Primary practice location

12 Bokum Rd
Essex, CT 06426-1500

Mailing address

12 Bokum Rd
Essex, CT 06426-1500
Phone (860) 767-9053

Other identifiers 1

IdentifierTypeStateIssuer
004246824MedicaidCT

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HGHBCD

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323302400000",
    "number": "1861425597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 BOKUM RD",
            "city": "ESSEX",
            "state": "CT",
            "postal_code": "064261500",
            "telephone_number": "860-767-9053",
            "fax_number": "860-767-1146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 BOKUM RD",
            "city": "ESSEX",
            "state": "CT",
            "postal_code": "064261500",
            "telephone_number": "860-767-9053",
            "fax_number": "860-767-1146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHORELINE ORTHOPEDICS & SPORTS MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2011-12-08",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "JEFFREY",
        "authorized_official_title_or_position": "PHYSICIAN PARTNER",
        "authorized_official_telephone_number": "860-767-9053",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CT",
            "license": "027273",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004246824",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Essex, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.