NPIMap

Organization Active NPI

Intercommunity, Inc.

  • Federally Qualified Health Center (FQHC)
  • East Hartford, CT
National Provider Identifier
1962896548
Registry record updated Jun 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
702 Issued in CT
Legal business name
INTERCOMMUNITY, INC.
Practice address
281 Main St
East Hartford, CT 06118-1823
Phone
(860) 569-5900
NPI assigned
Mar 23, 2015
Last updated
Jun 8, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2016

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

Authorized official

Name
Kimberly Beauregard, LCSWNPI 1053346510
Title
President & Ceo
Phone
(860) 291-1340

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 702 CT Primary

Addresses

Primary practice location

281 Main St
East Hartford, CT 06118-1823

Mailing address

111 Founders PLZ
Suite 1802
East Hartford, CT 06108-3212
Phone (860) 569-5900

Other identifiers 1

IdentifierTypeStateIssuer
008047966MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040329000218 CT Part B Supplier - Clinic/Group Practice 9032001649 Receives reassigned benefits from 80 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: East Hartford, CT; Hartford, CT; South Windsor, CT
O20150428000738 CT Part A Provider - Federally Qualified Health Center (FQHC) 9032001649 Practice locations: East Hartford, CT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1962896548. Details of each certification follow.

Federally qualified health center certification: CCN 071911

Legal name
INTERCOMMUNITY INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 18, 2015
Last certification
May 18, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 1, 1977 in CT
Enrollment address
281 Main St
East Hartford, CT 61181883

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Shah Hasmukh6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

101 Great Hill Rd
East Hartford, CT 06108
Phone (860) 622-5733

111 Founders Plz
Ste 1802
East Hartford, CT 06108
Phone 8605695900326

15 Mercer Ave
East Hartford, CT 06118
Phone (860) 622-5513

287 Main St
East Hartford, CT 06118
Phone (860) 716-2518

61 Alps Dr
East Hartford, CT 06108

777 Burnside Ave
East Hartford, CT 06108
Phone (860) 622-5340

869 Forbes St
East Hartford, CT 06118
Phone (860) 622-5340

16 Coventry St
Hartford, CT 06112
Phone (860) 714-3701

800 Connecticut Blvd
Fl 4
Hartford, CT 06108
Phone (860) 622-5451

828 Sullivan Ave
Bldg 1
South Windsor, CT 06074
Phone 8605695900319

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Tyler V.R. Booth Individual Corporate OfficerCoo Dec 27, 2009
Kimberly L Beauregard Individual Corporate OfficerCeo and President Nov 10, 2003 100%
Operational/Managerial Control Nov 10, 2003

Practitioners & affiliated clinicians

Practitioners 132

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 132

NPI Registry JSON

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

{
    "created_epoch": "1427068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465344000000",
    "number": "1962896548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 FOUNDERS PLZ",
            "address_2": "SUITE 1802",
            "city": "EAST HARTFORD",
            "state": "CT",
            "postal_code": "061083212",
            "telephone_number": "860-569-5900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "281 MAIN ST",
            "city": "EAST HARTFORD",
            "state": "CT",
            "postal_code": "061181823",
            "telephone_number": "860-569-5900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERCOMMUNITY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-23",
        "last_updated": "2016-06-08",
        "status": "A",
        "authorized_official_last_name": "BEAUREGARD",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "860-291-1340",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CT",
            "license": "702",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008047966",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Hartford, CT

Sources for this page

Verify at the official NPI Registry.