West Hartford Medical Center

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

WEST HARTFORD MEDICAL CENTER

Practice address

74 Park Rd Ste 4
West Hartford, CT 06119-1898

Phone

(860) 218-1725

NPI assigned

Sep 8, 2009

Organization subpart

No

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

Authorized official

Name

Mr. Angel C. Jaquez

Title

Director

Phone

(860) 218-1725

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Igor Samegulin, MD

  • Family Medicine Physician
  • West Hartford, CT
  • NPI 1255517249
  Medicare reassignment Care Compare group NPD
• Corey Jaquez, M.D.

  • Family Medicine Physician
  • Trumbull, CT
  • NPI 1205073962
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1252368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355788800000",
    "number": "1942533039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "74 PARK RD STE 4",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061191898",
            "telephone_number": "860-218-1725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "74 PARK RD STE 4",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061191898",
            "telephone_number": "860-218-1725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST HARTFORD MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-08",
        "last_updated": "2012-12-18",
        "status": "A",
        "authorized_official_last_name": "JAQUEZ",
        "authorized_official_first_name": "ANGEL",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "860-218-1725",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008022952",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6464646",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• West Hartford Family Dentistry
• West Hartford Health & Rehabilitation Center
• West Hartford Internal Medicine, LLC
• West Hartford Massage Clinic, LLC
• West Hartford Maxillofacial Surgery, PC
• West Hartford One Opco LLC
• West Hartford Pediatrics, LLC
• West Hartford Podiatry Associates PC
• West Hartford Primary Care, LLC
• West Hartford Therapy Center LLC

• Family Medicine Physician in West Hartford, CT
• Providers in West Hartford, CT by specialty
• Family Medicine Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.