James D Bovienzo, D.O.
Individual provider Active NPI Emergency Medicine Physician · Bridgeport, CT
NPI 1982641635 · NPPES record last updated Jun 20, 2014
Key facts
- NPI
- 1982641635
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 160395 (MA)
- Practice address
- 2800 Main St
St. Vincent'S Medical Center
Bridgeport, CT 06606-4201 - Phone
- (203) 576-5177
- NPI assigned
- Jun 1, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 16
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (6 enrollments) in CT, NY, NH, VT, HI, FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20031217000267 | CT | Practitioner - Emergency Medicine | 7810894912 | Reassigns benefits to 2 organizations |
| I20041023000224 | NY | Practitioner - Emergency Medicine | 7810894912 | Reassigns benefits to 2 organizations |
| I20051115001107 | NH | Practitioner - Emergency Medicine | 7810894912 | Reassigns benefits to 1 organization |
| I20060322000392 | VT | Practitioner - Emergency Medicine | 7810894912 | |
| I20180904002431 | HI | Practitioner - Emergency Medicine | 7810894912 | Reassigns benefits to 2 organizations |
| I20240624004260 | FL | Practitioner - Emergency Medicine | 7810894912 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 02816 | KY | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Delaware River Medicine, PLLC | Emergency Medicine | Current |
Accepting new patients |
| Littleton Hospital Association | Current |
Accepting new patients | |
| Nems PLLC | Emergency Medicine | Current |
Accepting new patients |
| Em Alliance LLC | Emergency Medicine | Current |
Accepting new patients |
| North Shore - Lij Medical PC | Current |
Accepting new patients | |
| Lanai Emergency Medical Associates Inc | Emergency Medicine | Current |
Accepting new patients |
| Northeast Emergency Medicine Specialists, LLC | Emergency Medicine | Current |
Accepting new patients |
| Maui Memorial Emergency Medical Associates Inc | Emergency Medicine | Current |
Accepting new patients |
| North Shore-Lij Medical PC | Emergency Medicine | Current |
Accepting new patients |
| Littleton Hospital Association | Current |
Accepting new patients | |
| Jackson Hospital Corporation | Emergency Medicine | Past | Accepting new patients |
| Hospital of Saint Raphael | Past | Accepting new patients | |
| Nes Medical Services of Northern Connecticut, P.C. | Emergency Medicine | Past |
Accepting new patients |
| Emergency Medicine Physicians of Albany County, PLLC | Emergency Medicine | Past | Accepting new patients |
| Connecticut Em-1 Medical Services, PC | Emergency Medicine | Past | Accepting new patients |
| Mep of Bristol, LLC | Emergency Medicine | Past | Accepting new patients |
Locations
71 Haynes St
Manchester, CT 06040
Phone (860) 533-2981
435 Lewis Ave
Meriden, CT 06451
Phone (203) 284-1340
320 Pomfret St
Putnam, CT 06260
Phone (860) 963-6331
81 Meriden Ave
Southington, CT 06489
Phone (860) 224-5540
31 Union St
Vernon Rockvl, CT 06066
Phone (860) 289-6451
64 Robbins St
Waterbury, CT 06708
Phone (203) 573-7142
112 Mansfield Ave
Willimantic, CT 06226
Phone (830) 423-6410
5506 14th St W
Bradenton, FL 34207
Phone (941) 745-7372
10101 Forest Hill Blvd
West Palm Beach, FL 33414
Phone (561) 766-1301
221 Mahalani St
Wailuku, HI 96793
Phone (808) 242-2290
600 Saint Johnsbury Rd
Littleton, NH 03561
Phone (603) 444-9000
90 Swiftwater Rd
Woodsville, NH 03785
Phone (603) 747-9000
10201 66th Rd
Forest Hills, NY 11375
Phone (718) 830-4091
300 Community Dr
Plandome, NY 11030
160 E Main St
Port Jervis, NY 12771
Phone (845) 856-7000
15 Maple Ave
Warwick, NY 10990
Phone (845) 986-2224
7 Easton Oval
#L4387
Columbus, OH 43219
Interoperability endpoints
- james.bovienzo@393409484357636.direct.elationemr.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 160395 | MA | Yes |
| Emergency Medicine Physician | 207P00000X | 02816 | KY |
Addresses
Primary practice location
2800 Main St
St. Vincent'S Medical Center
Bridgeport, CT 06606-4201
Mailing address
100 W 58TH St
Apt 6F
New York, NY 10019-2129
Phone (203) 576-5177
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7100050090 | Medicaid | KY | |
| 000000569669 | Other | KY | ANTHEM BCBS |
Other providers in Bridgeport, CT
- Agedi Nicholson Boto
- Michelle Bottone
- Melissa Boudreau
- Emilie Claire Bourgeois
- Megan Lynn Bourguillon
- Eiffel Bowen
- Marcus Pierre Bowen Jr.
- Yannick Bowen
- Jennifer L Boyd-Mullineaux
- Shamayra Viola Boyd
All providers in Bridgeport, CT · Emergency Medicine Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.