Active NPI
David E. Ciancimino, MD
- Psychiatry Physician
- Bridgeport, CT
National Provider Identifier
1992723282
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(4) exclusion effective Jun 20, 2023.
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 031679
- Practice address
- 4697 Main St
Bridgeport, CT 06606-1869 - Phone
- (203) 372-5695
- Fax
- (203) 459-0574
- NPI assigned
- Jul 17, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 031679 | CT | Primary |
Addresses
Primary practice location
4697 Main St
Bridgeport, CT 06606-1869
Mailing address
4697 Main St
Bridgeport, CT 06606-1869
Phone (203) 372-5695
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 010031679CT01 | Other | CT | BLUE CROSS |
| 168586 | Other | CT | MANAGED HEALTH NETWORK |
| 134581 | Other | CT | CIGNA |
| ZS814 | Other | CT | OXFORD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 031679 | CT | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1992723282",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4697 MAIN ST",
"city": "BRIDGEPORT",
"state": "CT",
"postal_code": "066061869",
"telephone_number": "203-372-5695",
"fax_number": "203-459-0574"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4697 MAIN ST",
"city": "BRIDGEPORT",
"state": "CT",
"postal_code": "066061869",
"telephone_number": "203-372-5695",
"fax_number": "203-459-0574"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CIANCIMINO",
"first_name": "DAVID",
"middle_name": "E.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CT",
"license": "031679",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "010031679CT01",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MANAGED HEALTH NETWORK",
"identifier": "168586",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "134581",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD",
"identifier": "ZS814",
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.