NPIMap

Organization Active NPI

Central Connecticut Radiation Oncology PC

  • Radiation Oncology Physician
  • Middletown, CT
National Provider Identifier
1902962905
Registry record updated Feb 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
Legal business name
CENTRAL CONNECTICUT RADIATION ONCOLOGY PC
Practice address
536 Saybrook Rd
Middlesex Hospital Cancer Center
Middletown, CT 06457
Phone
(860) 704-0106
Fax
(860) 704-0125
NPI assigned
Dec 28, 2006
Last updated
Feb 3, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2014

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

Authorized official

Name
Neal B Goldberg, MDNPI 1528173911
Title
Owner Partner
Phone
(860) 224-5520

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Oncology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RX0202X
Radiation Oncology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2085R0001X Primary

Addresses

Primary practice location

536 Saybrook Rd
Middlesex Hospital Cancer Center
Middletown, CT 06457

Mailing address

760 Saybrook Rd BLDG a
Middletown, CT 06457-4785
Phone (860) 704-0106

Other identifiers 1

IdentifierTypeStateIssuer
CCRO4074712MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070228000322 CT Part B Supplier - Clinic/Group Practice 5395847966 Receives reassigned benefits from 14 practitioners
Practice locations: Middletown, CT; New Britain, CT

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

536 Saybrook Rd
#C
Middletown, CT 06457
Phone (860) 358-2100

330 Washington St
Ste 110
Norwich, CT 06360

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391385600000",
    "number": "1902962905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "760 SAYBROOK RD BLDG A",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064574785",
            "telephone_number": "860-704-0106",
            "fax_number": "860-704-0125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "536 SAYBROOK RD",
            "address_2": "MIDDLESEX HOSPITAL CANCER CENTER",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "06457",
            "telephone_number": "860-704-0106",
            "fax_number": "860-704-0125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL CONNECTICUT RADIATION ONCOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-28",
        "last_updated": "2014-02-03",
        "status": "A",
        "authorized_official_last_name": "GOLDBERG",
        "authorized_official_first_name": "NEAL",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER PARTNER",
        "authorized_official_telephone_number": "860-224-5520",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RX0202X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Medical Oncology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Radiation Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CCRO4074712",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Middletown, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.