Mystic Medical Group, PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

MYSTIC MEDICAL GROUP, PC

Practice address

200 Sandy Hollow Rd
Mystic, CT 06355-1720

Phone

(860) 572-8911

Fax

(860) 572-7758

NPI assigned

Sep 15, 2005

Last updated

Dec 22, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Thomas March Blum, M.D.NPI 1194710210

Title

President

Phone

(860) 572-8911

Specialties & licenses 1

Addresses

Other identifiers 1

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.

• Thomas March Blum, M.D.

  • Internal Medicine Physician
  • Mystic, CT
  • NPI 1194710210
  Authorized official Same address or phone

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

{
    "created_epoch": "1126742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261440000000",
    "number": "1902891070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 SANDY HOLLOW RD",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "063551720",
            "telephone_number": "860-572-8911",
            "fax_number": "860-572-7758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 SANDY HOLLOW RD",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "063551720",
            "telephone_number": "860-572-8911",
            "fax_number": "860-572-7758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYSTIC MEDICAL GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-15",
        "last_updated": "2009-12-22",
        "status": "A",
        "authorized_official_last_name": "BLUM",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "MARCH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "860-572-8911",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004002861",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mystic Dental Group, P.C.
• Mystic Geriatrics, LLC
• Mystic Healthcare & Rehabilitation Center LLC (Mystic Manor)
• Mystic Healthcare and Rehabilitation Facility
• Mystic Medical Associates LLC
• Mystic River Ambulance Association, Inc
• Mystic Services, LLC (Mystic Bridge to Wellness)
• Mystic Spine & Sport LLC
• Mystic Therapy, LLC.
• Mystic Westerly Orthodontics, PC

• Internal Medicine Physician in Mystic, CT
• Providers in Mystic, 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 Dec 22, 2009; 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.