Individual provider Active NPI

Shihab Masrur, M.D.

  • Internal Medicine Physician
  • Hartford, CT
National Provider Identifier
1861623431
Registry record updated Aug 5, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
052284 Issued in CT
Practice address
80 Seymour Street
Hartford Hospital Cardiology Dept
Hartford, CT 06102-5037
Phone
(860) 972-4398
NPI assigned
Jul 30, 2009
Last updated
Aug 5, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 241713 MA
Internal Medicine Physician 207R00000X 052284 CT Primary

Addresses

Primary practice location

80 Seymour Street
Hartford Hospital Cardiology Dept
Hartford, CT 06102-5037

Mailing address

PO Box 415933
Hartford Hospital Professional Services
Boston, MA 02241-5933
Phone (860) 545-7602

Other identifiers 1

IdentifierTypeStateIssuer
001522846MedicaidCT

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
I20130819000793 CT Practitioner - Internal Medicine 4082856190 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prospect CT Medical Foundation IncGroup PAC ID 7416244496, 287 clinicians
Middlesex HospitalGroup PAC ID 5092611731, 231 clinicians

Practice addresses (Care Compare)

18 Haynes St
Uppr Level
Manchester, CT 06040-4111
Phone (860) 649-7557

28 Crescent St
Middletown, CT 06457-3654
Phone (860) 358-5322

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
052284CTMDInternal Medicine Physician
241713MAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Middlesex Hospital CurrentSince Dec 6, 2023 Accepting new patients
Prospect CT Medical Foundation, Inc. Internal Medicine CurrentSince Sep 1, 2016 Accepting new patients
Middlesex Hospital Internal Medicine CurrentSince Dec 6, 2023 Accepting new patients
Alliance Medical Group of Greater Waterbury PC Internal Medicine Past Accepting new patients

Locations

1801 W Olympic Blvd
#2201
Pasadena, CA 91199

18 Haynes St
Uppr
Manchester, CT 06040
Phone (860) 649-7557

28 Crescent St
Middletown, CT 06457
Phone (860) 358-6000

80 S Main St
Ste 102
Middletown, CT 06457
Phone (860) 358-6878

64 Robbins St
Waterbury, CT 06708
Phone (203) 573-7142

Interoperability endpoints

  • Direct secure messaging: smasrur85591@middlesexhealthprd.direct-ci.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1248912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375660800000",
    "number": "1861623431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 415933",
            "address_2": "HARTFORD HOSPITAL PROFESSIONAL SERVICES",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022415933",
            "telephone_number": "860-545-7602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 SEYMOUR STREET",
            "address_2": "HARTFORD HOSPITAL CARDIOLOGY DEPT",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061025037",
            "telephone_number": "860-972-4398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASRUR",
        "first_name": "SHIHAB",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-30",
        "last_updated": "2013-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "241713",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "052284",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001522846",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hartford, CT

Sources for this page

Verify at the official NPI Registry.