NPIMap

Organization Active NPI

Staywell Health Care Inc

  • Federally Qualified Health Center (FQHC)
  • Naugatuck, CT
National Provider Identifier
1982151635
Registry record updated Jan 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
STAYWELL HEALTH CARE INC
Practice address
30 Church St
Naugatuck, CT 06770-4112
Phone
(203) 805-4929
Fax
(844) 668-4620
NPI assigned
Sep 9, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2020

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

Authorized official

Name
Donald Thompson
Title
Ceo/President
Phone
(203) 756-8021

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 0787 CT
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X 0787 CT
Dental Clinic/Center 261QD0000X CT
Federally Qualified Health Center (FQHC) 261QF0400X CT Primary
Health Service Clinic/Center 261QH0100X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X CT

Addresses

Primary practice location

30 Church St
Naugatuck, CT 06770-4112

Mailing address

30 Church St
Naugatuck, CT 06770-4112
Phone (203) 805-4929

Other identifiers 4

IdentifierTypeStateIssuer
004235968MedicaidCT
004235976MedicaidCT
1154342335OtherCTANTHEM BCBS
004235984MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170713002332 CT Part A Provider - Federally Qualified Health Center (FQHC) 6305750480 Practice locations: Naugatuck, CT

Federally qualified health center certification: CCN 071930

Legal name
STAYWELL HEALTH CARE INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 13, 2017
Last certification
Jul 13, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 11, 1994 in CT
Enrollment address
30 Church St
Naugatuck, CT 67704112

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
Staywell Health Care Inc6 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

114 Benedict St
Waterbury, CT 06706

80 Phoenix Ave
Ste 201
Waterbury, CT 06702
Phone (203) 757-5491

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Thomas Johnson Individual Corporate OfficerSecretary Oct 15, 2012
Carolyn a Highsmith Individual Corporate OfficerTreasurer Feb 1, 2010
Sandra J Sorel-Leduc Individual Corporate OfficerVice Chair Mar 1, 2004
Lule G Tracey Individual Corporate DirectorCfo Feb 1, 1999
W-2 Managing EmployeeCfo Feb 1, 1999
Franklin M Tyson Individual Corporate DirectorBoard Member May 11, 2015
Donald J Thompson Individual Corporate OfficerCeo Sep 11, 1989
Corporate DirectorCeo Sep 11, 1989 100%
W-2 Managing EmployeeCeo Sep 11, 1989
Mark L Briggs Individual Corporate OfficerChairperson Feb 6, 2006
Wanda Dunbar Individual Corporate DirectorBoard Member Feb 18, 2019
Alison Campbell Individual Corporate DirectorBoard Member Oct 14, 2021

Practitioners & affiliated clinicians

Practitioners 46

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

View all 46

NPI Registry JSON

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

{
    "created_epoch": "1473379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578528000000",
    "number": "1982151635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 CHURCH ST",
            "city": "NAUGATUCK",
            "state": "CT",
            "postal_code": "067704112",
            "telephone_number": "203-805-4929",
            "fax_number": "844-668-4620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 CHURCH ST",
            "city": "NAUGATUCK",
            "state": "CT",
            "postal_code": "067704112",
            "telephone_number": "203-805-4929",
            "fax_number": "844-668-4620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STAYWELL HEALTH CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-09",
        "last_updated": "2020-01-09",
        "certification_date": "2020-01-09",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "203-756-8021"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CT",
            "license": "0787",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "CT",
            "license": "0787",
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "CT",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CT",
            "license": null,
            "primary": true
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "CT",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004235968",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004235976",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "1154342335",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004235984",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Naugatuck, CT

Sources for this page

Verify at the official NPI Registry.