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MEDICAL GROUP
NPI 1144677568
Family Medicine in Manchester, CT

Active since May 16, 2016CLIA Certified · 3 labs
71 HAYNES ST, MILLER BLDG., FLOOR G, MANCHESTER, CT 06040(860) 533-2981(860) 533-2975 Get Directions Write a Review

NPPES record last updated: March 15, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 15, 2021, Jan 15, 2021, Oct 17, 2018 and 1 more (4 updates tracked since 2016).

About Medical Group NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MEDICAL GROUP (NPI 1144677568) is a healthcare organization registered as a family medicine in Manchester, Connecticut and active in the NPI registry since May 2016. The organization holds 3 active CLIA laboratory certificates, maintains a secondary practice location in Watertown, and lists Robert Jon Elders, Secretary, as its authorized official.

NPPES Registry Identity

NPI1144677568
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NamePROSPECT CT MEDICAL FOUNDATION, INC.
Location Address71 HAYNES ST, MILLER BLDG., FLOOR GManchester, CT 06040-4131
Mailing Address71 Haynes St, Miller Bldg., Floor GManchester, CT 06040-4131 · (860) 533-2981 · Fax (860) 533-2975
Phone(860) 533-2981
Fax(860) 533-2975
Organization SubpartNo
Authorized OfficialRobert Jon EldersSecretary · (714) 788-1249
Enumeration DateMay 16, 2016
Last NPPES UpdateMarch 15, 20214 updates tracked since enumeration
NPPES CertifiedMarch 15, 2021
✔ NPI 1144677568 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 15

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Also ListedSocial Worker · ClinicalTaxonomy 1041C0700X
Also ListedMarriage & Family TherapistTaxonomy 106H00000X
Also ListedRegistered NurseTaxonomy 163W00000X
Also ListedInternal MedicineTaxonomy 207R00000X
Also ListedInternal Medicine · Endocrinology, Diabetes & MetabolismTaxonomy 207RE0101X
Also ListedInternal Medicine · GastroenterologyTaxonomy 207RG0100X
Also ListedObstetrics & Gynecology · Gynecologic OncologyTaxonomy 207VX0201X
Also ListedOrthopaedic SurgeryTaxonomy 207X00000X
Also ListedSurgeryTaxonomy 208600000X
Also ListedSurgery · Vascular SurgeryTaxonomy 2086S0129X
Also ListedThoracic Surgery (Cardiothoracic Vascular Surgery)Taxonomy 208G00000X
Also ListedHospitalistTaxonomy 208M00000X
Also ListedPhysician Assistant · MedicalTaxonomy 363AM0700X
Also ListedNurse PractitionerTaxonomy 363L00000X
71 HAYNES ST, Manchester, CT 06040
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Other Names 1

Other NameMedical Group

Secondary Practice Location 1

Location 1777 Echo Lake Rd Unit AWatertown, CT 06795-6618 · Phone (860) 274-5497 · Fax (203) 575-5215

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA 3

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 07D2331106

Prospect Ct Medical Foundation, Inc - Urology · Manchester, CT
Active · expires Sep 25, 2027
CLIA Number07D2331106
Laboratory TypePhysician Office
Certificate Effective DateSeptember 26, 2025
Certificate Expiration DateSeptember 25, 2027
Laboratory DirectorDr. Kai Hammerich
Laboratory Phone(860) 647-4721
Laboratory LocationProspect Ct Medical Foundation, Inc - Urology29 Haynes Street, Suite B, Manchester, CT 06040
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 07D1042131

Prospect Ct Medical Foundation-Manchester · Manchester, CT
Active · expires Jun 20, 2027
CLIA Number07D1042131
Laboratory TypePhysician Office
Certificate Effective DateJune 21, 2025
Certificate Expiration DateJune 20, 2027
Laboratory DirectorRemi Mathews
Laboratory Phone(860) 533-4673
Laboratory LocationProspect Ct Medical Foundation-Manchester130 Hartford Road, Manchester, CT 06040
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 07D0691953

Prospect Ct Medical Foundation Inc Manchester Family · Manchester, CT
Active · expires Aug 31, 2026
CLIA Number07D0691953
Laboratory TypePhysician Office
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorJames R. Doran
Laboratory Phone(860) 649-6900
Laboratory LocationProspect Ct Medical Foundation Inc Manchester Family629 Middle Tpke East, Manchester, CT 06040
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. FRANKLIN GEORGE GILLIG M.D.
Emergency Medicine
71 HAYNES ST
MANCHESTER, CT 06040
Capitol Planning Region (860) 646-1222
MRS. CORY BERNARD LCSW
Social Worker (Clinical)
71 HAYNES ST, BEHAVIORAL HEALTH UNIT
MANCHESTER, CT 06040
Capitol Planning Region (860) 646-1222
DR. DINESH S. SHAH M.D.
Emergency Medicine
71 HAYNES ST
MANCHESTER, CT 06040
Capitol Planning Region (860) 646-1222
DANIELLE KIREI PA
Physician Assistant
71 HAYNES ST
MANCHESTER, CT 06040
Capitol Planning Region (860) 646-1222
RAJITHA REDDY
Student in an Organized Health Care Education/Training Program
71 HAYNES ST
MANCHESTER, CT 06040
Capitol Planning Region (860) 533-4679
DR. ALLANA R LEE D.O.
Psychiatry & Neurology (Child & Adolescent Psychiatry)
71 HAYNES ST
MANCHESTER, CT 06040
Capitol Planning Region (860) 646-1222
ANDREA LYNCH PA-C
Physician Assistant (Surgical)
71 HAYNES ST
MANCHESTER, CT 06040
Capitol Planning Region (860) 533-6595
JAMSHID A MARVASTI, M.D. P.C.
Psychiatry & Neurology (Psychiatry)
71 HAYNES ST, MMH
MANCHESTER, CT 06040
Capitol Planning Region (860) 643-1166

Frequently 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 Prospect Ct Medical Foundation, Inc.'s NPI number?

The NPI number for Prospect Ct Medical Foundation, Inc. is 1144677568. It was assigned to this organization in the NPPES registry on May 16, 2016. The provider is also known as Medical Group.

Where is Prospect Ct Medical Foundation, Inc. located?

Prospect Ct Medical Foundation, Inc. is located at 71 Haynes St Miller Bldg., Floor G, Manchester, CT 06040. The listed phone number is (860) 533-2981.

What is Prospect Ct Medical Foundation, Inc.'s specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Prospect Ct Medical Foundation, Inc. hold CLIA laboratory certificates?

Yes. 3 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Prospect Ct Medical Foundation, Inc. was last updated on March 15, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years 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.