COLLABORATIVE MEDICINE LLC
NPI 1063137511
Nurse Practitioner - Family in Canton, CT
About Collaborative Medicine Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
COLLABORATIVE MEDICINE LLC (NPI 1063137511) is a healthcare organization registered as a family in Canton, Connecticut and active in the NPI registry since October 2022. The organization holds a CLIA Waiver certificate valid through January 8, 2027, maintains a secondary practice location in Burlington, and lists Jennifer Cannon, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Collaborative Medicine Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
4Medicare enrollment records show 4 clinicians reassign Medicare billing to Collaborative Medicine LLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 3 within 10 miles. They are listed nearest first.
Clinicians, nearest first (4)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 07D2274619
Collaborative Medicine LLC · Canton, CTFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Collaborative Medicine LLC's NPI number?
The NPI number for Collaborative Medicine LLC is 1063137511. It was assigned to this organization in the NPPES registry on October 6, 2022.
Where is Collaborative Medicine LLC located?
Collaborative Medicine LLC is located at 166 Albany Tpke Ste 7, Canton, CT 06019. The listed phone number is (860) 935-6680.
What is Collaborative Medicine LLC's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Collaborative Medicine LLC enrolled in Medicare?
Yes. Collaborative Medicine LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Collaborative Medicine LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Collaborative Medicine LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice at this address and 3 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Collaborative Medicine LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 07D2274619) is associated with this NPI, valid through January 8, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Collaborative Medicine LLC accept?
Health plans from Anthem Blue Cross and Blue Shield list Collaborative Medicine LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Collaborative Medicine LLC was last updated on May 22, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Collaborative Medicine Llc · NPI 1063137511
Family organization in Canton, Connecticut. Organization record, active in the CMS NPPES registry since October 6, 2022.
## Identity
- **NPI:** 1063137511 (Entity type: Organization)
- **Enumerated:** October 6, 2022
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **Organization subpart:** No
- **Authorized official:** Jennifer Cannon, OWNER
## Practice location
- **Address:** 166 ALBANY TPKE STE 7, Canton, CT 06019-2546
- **Phone:** (860) 935-6680 · **Fax:** (860) 359-3701
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 4 clinicians (Nurse Practitioner) reassign Medicare billing to this organization (form CMS-855R); 1 practice at this address and 3 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** May 22, 2025
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1063137511) · Data from the CMS NPPES public registry.