NPIMap

Organization Active NPI

Optimus Healthcare

  • Dental Clinic/Center
  • Bridgeport, CT
National Provider Identifier
1972907012
Registry record updated Oct 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
006486 Issued in CT
Legal business name
OPTIMUS HEALTHCARE
Practice address
982 E Main St
Dental Department
Bridgeport, CT 06608-1913
Phone
(203) 696-3260
Fax
(203) 334-8104
NPI assigned
Oct 17, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2014

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

Authorized official

Name
Dr. Kris Kotsay, DMD
Title
Dental Director
Phone
(203) 696-3260

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 006486 CT Primary

Addresses

Primary practice location

982 E Main St
Dental Department
Bridgeport, CT 06608-1913

Mailing address

982 E Main St
Dental Department
Bridgeport, CT 06608-1913
Phone (203) 696-3260

Other identifiers 1

IdentifierTypeStateIssuer
1669548376MedicaidCT

National Provider Directory

National Provider Directory
Tax ID family
Optimus Health Care Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

NPI Registry JSON

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

{
    "created_epoch": "1413504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413504000000",
    "number": "1972907012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "982 E MAIN ST",
            "address_2": "DENTAL DEPARTMENT",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066081913",
            "telephone_number": "203-696-3260",
            "fax_number": "203-334-8104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "982 E MAIN ST",
            "address_2": "DENTAL DEPARTMENT",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066081913",
            "telephone_number": "203-696-3260",
            "fax_number": "203-334-8104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTIMUS HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-17",
        "last_updated": "2014-10-17",
        "status": "A",
        "authorized_official_last_name": "KOTSAY",
        "authorized_official_first_name": "KRIS",
        "authorized_official_title_or_position": "DENTAL DIRECTOR",
        "authorized_official_telephone_number": "203-696-3260",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "CT",
            "license": "006486",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1669548376",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeport, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.