NPIMap

Organization Active NPI

Quinnipiac Medical of Branford, LLC

  • Internal Medicine Physician
  • Branford, CT
National Provider Identifier
1982668240
Registry record updated Feb 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
QUINNIPIAC MEDICAL OF BRANFORD, LLC
Practice address
960 Main St
Branford, CT 06405-3730
Phone
(203) 488-6358
Fax
(203) 481-5327
NPI assigned
Apr 13, 2006
Last updated
Feb 3, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2022

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

Authorized official

Name
Mary Kay Taylor
Title
Office Manager
Phone
(203) 488-6358

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

960 Main St
Branford, CT 06405-3730

Mailing address

960 Main St
Branford, CT 06405-3730
Phone (203) 488-6358

Other identifiers 4

IdentifierTypeStateIssuer
C02646OtherCTMEDICARE
50QUINLLCT01OtherCTANTHEM BCBS
CH3185OtherCTRAILROAD MEDICARE
004208931MedicaidCT

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040329000728 CT Part B Supplier - Clinic/Group Practice 8224920798 Receives reassigned benefits from 14 practitioners
Practice locations: Branford, CT

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
07D0694171Quinnipiac Medical of Branford, LLC960 Main St, Branford, CT 06405Certificate of waiverAug 3, 2027

National Provider Directory

National Provider Directory

Locations

960 Main St
Branford, CT 06405
Phone (203) 488-6358

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/27673/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 27

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1144886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643846400000",
    "number": "1982668240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "960 MAIN ST",
            "city": "BRANFORD",
            "state": "CT",
            "postal_code": "064053730",
            "telephone_number": "203-488-6358",
            "fax_number": "203-481-5327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "960 MAIN ST",
            "city": "BRANFORD",
            "state": "CT",
            "postal_code": "064053730",
            "telephone_number": "203-488-6358",
            "fax_number": "203-481-5327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUINNIPIAC MEDICAL OF BRANFORD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-13",
        "last_updated": "2022-02-03",
        "certification_date": "2022-02-03",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "MARY KAY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "203-488-6358"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "C02646",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "50QUINLLCT01",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CH3185",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004208931",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Branford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.