Individual provider Active NPI

Imelda Angelica Perez Cirilo, M.D.

  • Internal Medicine Physician
  • Manchester, CT
National Provider Identifier
1962780940
Registry record updated Feb 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
53099 Issued in CT
Practice address
629 Middle Tpke E
Manchester, CT 06040-3731
Phone
(860) 649-6900
NPI assigned
Jul 25, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MT198543 PA
Internal Medicine Physician 207R00000X 53099 CT Primary

Addresses

Primary practice location

629 Middle Tpke E
Manchester, CT 06040-3731

Mailing address

629 Middle Tpke E
Manchester, CT 06040-3731
Phone (860) 649-6900

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20140814000082 CT Practitioner - Internal Medicine 3678714698 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2007
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)

194 Howard St
New London, CT 06320-5544
Phone (860) 444-3366

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
53099CTMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hospitalist Medicine Physicians of Connecticut, LLC Internal Medicine CurrentSince Sep 1, 2015 Accepting new patients
Northeast Medical Group, Inc. Internal Medicine CurrentSince May 11, 2020 Accepting new patients

Locations

71 Haynes St
Manchester, CT 06040
Phone (860) 533-2981

194 Howard St
New London, CT 06320
Phone (860) 442-0564

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

31 Union St
Vernon Rockvl, CT 06066
Phone (860) 289-6451

Interoperability endpoints

  • Direct secure messaging: iperezcirilo454660@direct.ynhh.org

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 6

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": "1311552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580688000000",
    "number": "1962780940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "629 MIDDLE TPKE E",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060403731",
            "telephone_number": "860-649-6900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "629 MIDDLE TPKE E",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060403731",
            "telephone_number": "860-649-6900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CIRILO",
        "first_name": "IMELDA ANGELICA",
        "middle_name": "PEREZ",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-25",
        "last_updated": "2020-02-03",
        "certification_date": "2020-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MT198543",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "53099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, CT

Sources for this page

Verify at the official NPI Registry.