Individual provider Active NPI

Terence P Connelly, MD

  • Interventional Cardiology Physician
  • Port Charlotte, FL
National Provider Identifier
1982617072
Registry record updated Apr 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
ME63964 Issued in FL
Practice address
3340 Tamiami TRL
Port Charlotte, FL 33952-8088
Phone
(941) 764-5858
Fax
(941) 764-1657
NPI assigned
Aug 13, 2006
Last updated
Apr 1, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X ME0063964 FL
Interventional Cardiology Physician 207RI0011X ME63964 FL Primary

Addresses

Primary practice location

3340 Tamiami TRL
Port Charlotte, FL 33952-8088

Mailing address

2675 Winkler Ave FL 2
Fort Myers, FL 33901-9342
Phone (877) 856-3774

Other practice location 1

1912 Kings Hwy Unit 700
Port Charlotte, FL 33980-4305
Phone (941) 764-5858

Other practice location 2

25097 Olympia Ave Ste 102
Punta Gorda, FL 33950-3912
Phone (941) 237-7100

Other practice location 3

713 E Marion Ave
Punta Gorda, FL 33950-3872
Phone (941) 764-5858

Other identifiers 1

IdentifierTypeStateIssuer
374413200MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20041215000792 FL Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Diagnostic Radiology 7517944887 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Wayne State University School of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Millennium Physician Group LLCGroup PAC ID 9830244433, 976 clinicians

Practice addresses (Care Compare)

3340 Tamiami TRL
Port Charlotte, FL 33952-8088
Phone (941) 237-7100

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting1-10
Pacemaker insertion or repair1-10
Varicose vein removal18
Leg revascularization (restoring blood flow)1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME0063964FLMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Millennium Physician Group LLC CurrentSince Dec 6, 2021 Accepting new patients
Millennium Physician Group LLC CurrentSince Dec 6, 2021 Accepting new patients
Advanced Imaging of Port Charlotte Past Accepting new patients
Cardiology Associates of Charlotte County, PA Interventional Cardiology Past Accepting new patients
Arturo Rodriguez-Martin MD PL Past Accepting new patients

Locations

2675 Winkler Ave
Fl 2
Fort Myers, FL 33901
Phone (855) 979-5700

1912 Kings Hwy
Unit 700
Port Charlotte, FL 33980
Phone (941) 255-0032

19531 Cochran Blvd
Pt Charlotte, FL 33948
Phone (941) 255-3535

2525 Harbor Blvd
Ste 104
Pt Charlotte, FL 33952
Phone (941) 629-5757

3340 Tamiami Trl
Pt Charlotte, FL 33952
Phone (941) 764-5858

25097 Olympia Ave
Ste 102
Punta Gorda, FL 33950
Phone (941) 237-7100

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 5

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

Hospital & facility affiliations 2

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": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711929600000",
    "number": "1982617072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2675 WINKLER AVE FL 2",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339019342",
            "telephone_number": "877-856-3774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3340 TAMIAMI TRL",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339528088",
            "telephone_number": "941-764-5858",
            "fax_number": "941-764-1657"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1912 Kings Hwy Unit 700",
            "address_purpose": "LOCATION",
            "city": "Port Charlotte",
            "state": "FL",
            "postal_code": "339804305",
            "country_code": "US",
            "telephone_number": "941-764-5858",
            "fax_number": "941-257-8404",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "25097 Olympia Ave Ste 102",
            "address_purpose": "LOCATION",
            "city": "Punta Gorda",
            "state": "FL",
            "postal_code": "339503912",
            "country_code": "US",
            "telephone_number": "941-237-7100",
            "fax_number": "941-639-3805",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "713 E Marion Ave",
            "address_purpose": "LOCATION",
            "city": "Punta Gorda",
            "state": "FL",
            "postal_code": "339503872",
            "country_code": "US",
            "telephone_number": "941-764-5858",
            "fax_number": "941-764-1657",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CONNELLY",
        "first_name": "TERENCE",
        "middle_name": "P",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-13",
        "last_updated": "2024-04-01",
        "certification_date": "2024-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME0063964",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "FL",
            "license": "ME63964",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "374413200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Charlotte, FL

Sources for this page

Verify at the official NPI Registry.