NPIMap

Individual provider Active NPI

Kelli Donovan-Wright, M.D.

  • Internal Medicine Physician
  • Trumbull, CT
National Provider Identifier
1932507647
Registry record updated Oct 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
68049 Issued in CT
Practice address
51 Birdsall Ave
Trumbull, CT 06611-2453
Phone
(559) 307-0298
NPI assigned
Dec 11, 2014
Last updated
Oct 26, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 26, 2021

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 68049 CT Primary

Addresses

Primary practice location

51 Birdsall Ave
Trumbull, CT 06611-2453

Mailing address

13935 Bandix Rd SE
Olalla, WA 98359-9414
Phone (559) 307-0298

Other names 1

  • Kelley Donovan Former name

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
I20210923000491 CT Practitioner - Internal Medicine 5698172302 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Northeast Medical Group IncGroup PAC ID 1254233836, 1,357 clinicians

Practice addresses (Care Compare)

3180 Main St
Suite 301
Bridgeport, CT 06606-4237
Phone (203) 373-9100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
86.54
Promoting interoperability
99.98
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
68049CTMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Medical Group, Inc. Internal Medicine CurrentSince Oct 1, 2021 Accepting new patients

Locations

3180 Main St
Ste 301
Bridgeport, CT 06606
Phone (203) 373-9100

95 Armory Rd
Stratford, CT 06614
Phone (203) 384-3388

Interoperability endpoints

  • Direct secure messaging: kdonovan446914@direct.ynhh.org

Organizations & group practices 1

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 9

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": "1418256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635206400000",
    "number": "1932507647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13935 BANDIX RD SE",
            "city": "OLALLA",
            "state": "WA",
            "postal_code": "983599414",
            "telephone_number": "559-307-0298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 BIRDSALL AVE",
            "city": "TRUMBULL",
            "state": "CT",
            "postal_code": "066112453",
            "telephone_number": "559-307-0298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONOVAN-WRIGHT",
        "first_name": "KELLI",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-12-11",
        "last_updated": "2021-10-26",
        "certification_date": "2021-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "68049",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLEY",
            "last_name": "DONOVAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Trumbull, CT

Sources for this page

Verify at the official NPI Registry.