Theddeus Iheanacho, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

49777 Issued in CT

Practice address

203 Broad St
Suite C-4
Milford, CT 06460-4751

Phone

(203) 874-0593

Fax

(203) 877-8053

NPI assigned

Aug 5, 2010

Last updated

Jul 16, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Psychiatry

Education

Other, 1998

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Charter Oak Health Center, IncGroup PAC ID 3870401078, 37 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Charter Oak Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Hartford, CT
  • NPI 1992750855
  Medicare reassignment Care Compare group NPD
• Living Spring LLC

  • Psychiatry Physician
  • Milford, CT
  • NPI 1730549759
  Medicare reassignment NPD Authorized official
• Living Spring LLC

  • Psychiatry Physician
  • Milford, CT
  • NPI 1043584535
  Medicare reassignment Authorized official
• Neighborhood Health, Inc.

  dba HHC Neighborhood Health

  • General Practice Physician
  • Torrington, CT
  • NPI 1043544489

  Psychiatry

  Medicare reassignment NPD
• Trinity Health of New England Provider Network Organization Inc

  dba Trinity Health Of New England Medical Group

  • Internal Medicine Physician
  • Hartford, CT
  • NPI 1003882812
  Medicare reassignment NPD
• Silver Hill Hospital, Inc

  • Psychiatric Hospital
  • New Canaan, CT
  • NPI 1982658035
  Medicare reassignment
• Charter Oak Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Hartford, CT
  • NPI 1841937679
  NPD
• Trinity Health of New England Provider Network Organization Inc

  dba Trinity Health Of New England Medical Group

  • Internal Medicine Physician
  • Waterville, ME
  • NPI 1134779531
  NPD
• Community Health Alliance PLLC

  • Pain Medicine (Anesthesiology) Physician
  • Chicago, IL
  • NPI 1124610704
  NPD (past)

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

{
    "created_epoch": "1280966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342396800000",
    "number": "1922312503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 BROAD ST",
            "address_2": "SUITE C-4",
            "city": "MILFORD",
            "state": "CT",
            "postal_code": "064604751",
            "telephone_number": "203-874-0593",
            "fax_number": "203-877-8053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 BROAD ST",
            "address_2": "SUITE C-4",
            "city": "MILFORD",
            "state": "CT",
            "postal_code": "064604751",
            "telephone_number": "203-874-0593",
            "fax_number": "203-877-8053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IHEANACHO",
        "first_name": "THEDDEUS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-08-05",
        "last_updated": "2012-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "258158",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CT",
            "license": "49777",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Phung M Huynh, MD
• Melvyn Hyman, PHD
• Caitlin Iannucci, LPC, ATR
• Laura Dianey Ibanez, MD
• Jahanzaib Idrees, MD, MPH
• Brian Ing
• Christi Ingram, LCSW, LADC
• Innovative Neurology of Connecticut, LLC
• Institute for Educational Planning
• Integrative Psychotherapy Associates, LLC

• Psychiatry Physician in Milford, CT
• Providers in Milford, CT by specialty
• Psychiatry Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2012; 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.