Tracey Melissa Modeste

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

66924 Issued in CT

Practice address

305 Church St Ste 15
Naugatuck, CT 06770-2836

Phone

(203) 729-6641

Fax

(203) 575-5206

NPI assigned

Mar 29, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Tracey Mellisa Gaff Former name

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

Specialty

Internal Medicine

Education

University of Connecticut School of Medicine, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Prospect CT Medical Foundation IncGroup PAC ID 7416244496, 287 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Waterbury Hospital Hospital, Waterbury, CT, CCN 070005

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: traceymodeste@amggw.allscriptsdirect.net

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.

• Prospect CT Medical Foundation, Inc.

  • Family Medicine Physician
  • Manchester, CT
  • NPI 1144677568
  Medicare reassignment Care Compare group

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

• Prospect Waterbury, Inc.

  • General Acute Care Hospital
  • Waterbury, CT
  • NPI 1477902641
  Care Compare affiliation

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

{
    "created_epoch": "1490745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642723200000",
    "number": "1871025973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "64 ROBBINS STREET",
            "address_2": "WATERBURY HOSPITAL,",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "06708",
            "telephone_number": "203-573-6162",
            "fax_number": "203-573-6707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 CHURCH ST STE 15",
            "city": "NAUGATUCK",
            "state": "CT",
            "postal_code": "067702836",
            "telephone_number": "203-729-6641",
            "fax_number": "203-575-5206"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "160 Robbins Street",
            "address_2": "Chase Outpatient Center,",
            "address_purpose": "LOCATION",
            "city": "Waterbury",
            "state": "CT",
            "postal_code": "06708",
            "country_code": "US",
            "telephone_number": "203-573-7284",
            "fax_number": "203-573-7031",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MODESTE",
        "first_name": "TRACEY",
        "middle_name": "MELISSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-29",
        "last_updated": "2022-01-21",
        "certification_date": "2022-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "66924",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRACEY",
            "last_name": "GAFF",
            "middle_name": "MELLISA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Diane Michaelsen, LCSW
• Alexandra Migani, LCSW
• Dawn Marie Mikaitis, DMD
• Sarah Elizabeth Milewski
• Ashley D Miller, LCSW
• Melissa L Monahan, RPT
• Ronda Ott Morgan, PHARMD
• Kelly Morin-Irwin, DPT
• Rudo Mupoperi-Exantus, FNP-C
• Becky Murphy, COTA

• Internal Medicine Physician in Naugatuck, CT
• Providers in Naugatuck, CT by specialty
• Internal Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2022; 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.

Verify at the official NPI Registry.