Individual provider Active NPI

Paul Thomas Fidrych, DNP

  • Nurse Practitioner
  • Norwich, CT
National Provider Identifier
1972121630
Registry record updated Aug 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
8948 Issued in CT
Practice address
1 Towne Park PLZ
Norwich, CT 06360-2247
Phone
(860) 886-1433
NPI assigned
Jul 9, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Nurse Practitioner 363L00000X 8948 CT Primary

Addresses

Primary practice location

1 Towne Park PLZ
Norwich, CT 06360-2247

Mailing address

1 Towne Park PLZ
Norwich, CT 06360-2247
Phone (860) 886-1433

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201112001795 CT Practitioner - Nurse Practitioner 2163832650 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Hartford Healthcare Medical Group Specialists PLLCGroup PAC ID 3173866241, 1,555 clinicians

Practice addresses (Care Compare)

1 Towne Park PLZ
Norwich, CT 06360-2247
Phone (860) 886-1433

Hospital & facility affiliations

  • William W Backus Hospital Hospital, Norwich, CT, CCN 070024
  • Windham Community Memorial Hospital Hospital, Willimantic, CT, CCN 070021

Merit-based Incentive Payment System (MIPS)

Final score
90.42 of 100Reported as group
Quality
83.36
Promoting interoperability
100
Improvement activities
40
Cost
75.9

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
8948CTMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Hartford Healthcare Medical Group Specialists LLC CurrentSince Aug 1, 2020 Accepting new patients
Hartford Healthcare Medical Group Specialists, PLLC Nurse Practitioner CurrentSince Aug 1, 2020 Accepting new patients

Locations

1 Towne Park Plz
Norwich, CT 06360
Phone (860) 886-1433

1244 Storrs Rd
Storrs Mansfield, CT 06268
Phone (860) 724-2579

1290 Silas Deane Hwy
Wethersfield, CT 06109
Phone (860) 972-6977

Interoperability endpoints

  • Direct secure messaging: paul.fidrych@xdr.hhchealthdirect.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 4

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": "1594252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596240000000",
    "number": "1972121630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 TOWNE PARK PLZ",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063602247",
            "telephone_number": "860-886-1433",
            "fax_number": "860-886-4644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 TOWNE PARK PLZ",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063602247",
            "telephone_number": "860-886-1433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FIDRYCH",
        "first_name": "PAUL",
        "middle_name": "THOMAS",
        "credential": "DNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-09",
        "last_updated": "2020-08-01",
        "certification_date": "2020-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CT",
            "license": "8948",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norwich, CT

Sources for this page

Verify at the official NPI Registry.