MHS Primary Care
Organization Active NPI Internal Medicine Physician · Essex, CT
NPI 1992922892 · NPPES record last updated Jan 20, 2017
Key facts
- NPI
- 1992922892
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- MHS PRIMARY CARE
- Practice address
- 147 Westbrook Rd
Essex, CT 06426-1512 - Phone
- (860) 767-8265
- Fax
- (860) 767-6360
- NPI assigned
- Apr 20, 2007
- Organization subpart
- No
Authorized official
- Name
- Ms. Susan Serkey
- Title
- Practice Administrator
- Phone
- (860) 358-4802
Other NPIs on the same Medicare enrollment 12
Corporate family (same tax ID) 16
Practitioners 4
-
Eric Fisher, D.O.
-
Deirdre Pagan, APRN
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 07D0096347 | MHS Primary Care-Essex Med Group | Certificate of waiver | Apr 29, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040202000945 | CT | Part B Supplier - Clinic/Group Practice | 4082507371 |
Receives reassigned benefits from 218 practitioners 12 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Middletown, CT; Moodus, CT; New Haven, CT; Old Saybrook, CT; Portland, CT; Westbrook, CT; Marlborough, CT; Madison, CT… |
National Provider Directory
- Tax ID family
- MHS Primary Care Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | CT | ||
| Internal Medicine Physician |
207R00000X | Yes | ||
| Physician Assistant |
363A00000X | |||
| Family Nurse Practitioner |
363LF0000X |
Addresses
Primary practice location
147 Westbrook Rd
Essex, CT 06426-1512
Mailing address
28 Crescent St
Middletown, CT 06457-3654
Phone (860) 358-4819
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04181343 | Medicaid | CT |
Other names
- Essex Medical Group
Other providers in Essex, CT
- Zoe McGlamery
- Stacy McHugh
- Thomas Morgan McManus
- Charlayne McStay
- Shelby Mehmet
- MHS Primary Care Inc
- MHS Primary Care Inc
- Tomasz Michalak
- Middlesex Hospital
- Middlesex Wellness & Mediation, LLC
All providers in Essex, CT · Internal 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 Jan 20, 2017. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.