NPIMap

Individual provider Active NPI

Edward Martin Tristine, M.D

  • Internal Medicine Physician
  • Trumbull, CT
National Provider Identifier
1881700631
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
038590 Issued in CT
Practice address
17 Church Hill Rd
Trumbull, CT 06611-3116
Phone
(203) 696-3550
NPI assigned
Aug 22, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 038590 CT Primary

Addresses

Primary practice location

17 Church Hill Rd
Trumbull, CT 06611-3116

Mailing address

17 Church Hill Rd
Trumbull, CT 06611-3116
Phone (203) 696-3550

Other identifiers 1

IdentifierTypeStateIssuer
001385906MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051114000969 CT Practitioner - Internal Medicine 3971522459 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Hahnemann University College of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Hartford Healthcare Medical Group Specialists PLLCGroup PAC ID 3173866241, 1,555 clinicians
Rehabilitation Associates IncGroup PAC ID 8022905322, shared by 2 NPIs, 525 clinicians

Practice addresses (Care Compare)

1244 Storrs Rd
Road
Storrs, CT 06268-2200
Phone (860) 724-2579

17 Church Hill Rd
Trumbull, CT 06611-3116
Phone (203) 696-3550

1931 Black Rock Tpke
Fairfield, CT 06825-3506
Phone (203) 384-8681

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.42 of 100Reported as group
Quality
83.36
Promoting interoperability
100
Improvement activities
40
Cost
75.9

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
038590CTMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hartford Healthcare Medical Group Specialists, PLLC CurrentSince Jul 28, 2020 Accepting new patients
Neighborhood Health, Inc. Internal Medicine CurrentSince Mar 1, 2012 Accepting new patients
Hartford Healthcare Medical Group Specialists LLC CurrentSince Jul 28, 2020 Accepting new patients

Locations

2660 Main St
Bridgeport, CT 06606
Phone (203) 332-4744

2660 Main St
Ste 210
Bridgeport, CT 06606
Phone (203) 334-2246

2800 Main St
Bridgeport, CT 06606
Phone (203) 386-0366

1244 Storrs Rd
Storrs Mansfield, CT 06268
Phone (860) 724-2579

17 Church Hill Rd
Trumbull, CT 06611
Phone (203) 261-0800

5520 Park Ave
Ste 208
Trumbull, CT 06611
Phone (203) 368-1192

1290 Silas Deane Hwy
Wethersfield, CT 06109
Phone (860) 972-6977

Interoperability endpoints

  • Direct secure messaging: edward.tristine@xdr.hhchealthdirect.org

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Cambridge Health & Rehabilitation CenterFairfield, CT, CCN 075323 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jul 1, 2018
Dec 3, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

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 12

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": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1881700631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 CHURCH HILL RD",
            "city": "TRUMBULL",
            "state": "CT",
            "postal_code": "066113116",
            "telephone_number": "203-696-3550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 CHURCH HILL RD",
            "city": "TRUMBULL",
            "state": "CT",
            "postal_code": "066113116",
            "telephone_number": "203-696-3550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRISTINE",
        "first_name": "EDWARD",
        "middle_name": "MARTIN",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-22",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "038590",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001385906",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Trumbull, CT

Sources for this page

Verify at the official NPI Registry.