INNOVATIVE HEALTHCARE OF CONNECTICUT LLC
NPI 1619567260
Nurse Practitioner - Family in Manchester, CT

Q: What is Innovative Healthcare Of Connecticut LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Active since January 19, 2021CLIA 07D2220011 · Waiver

112 SPENCER ST STE 2A, MANCHESTER, CT 06040(860) 791-8170(860) 791-8208 Get Directions Write a Review

NPPES record last updated: May 23, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: May 23, 2025, Jan 19, 2021 (2 updates tracked since 2021).

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About Innovative Healthcare Of Connecticut Llc NPPES

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

INNOVATIVE HEALTHCARE OF CONNECTICUT LLC (NPI 1619567260) is a healthcare organization registered as a family in Manchester, Connecticut and active in the NPI registry since January 2021. The organization holds a CLIA Waiver certificate valid through April 7, 2027 and lists Camylle Appiahene, Nurse Practitioner/owner, as its authorized official.

NPPES Registry Identity

NPI1619567260

Entity TypeOrganization

Primary Taxonomy363LF0000X

Legal Business NameINNOVATIVE HEALTHCARE OF CONNECTICUT LLC

Location Address112 SPENCER ST STE 2AManchester, CT 06040-4601

Mailing Address112 Spencer St Ste 2aManchester, CT 06040-4601 · (860) 791-8170 · Fax (860) 791-8208

Phone(860) 791-8170

Fax(860) 791-8208

Organization SubpartNo

Authorized OfficialCamylle AppiaheneNurse Practitioner/owner · (860) 985-6259

Enumeration DateJanuary 19, 2021

Last NPPES UpdateMay 23, 20252 updates tracked since enumeration

NPPES CertifiedMay 23, 2025

✔ NPI 1619567260 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

112 SPENCER ST STE 2A, Manchester, CT 06040

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Innovative Healthcare Of Connecticut Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by October 31, 2026

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date

StateConnecticutEnrollment IDO20211006003240Non-DME Part B · Mass Immunization (Roster Biller Only)Due dateOctober 31, 2026

Source: CMS Revalidation Due Date List, October 2026 release.

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 2 clinicians reassign Medicare billing to Innovative Healthcare Of Connecticut LLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 2 within 10 miles. They are listed nearest first.

Clinicians, nearest first (2)

Camylle Appiahene, APRN

Nurse Practitioner

NPI 1700206018

112 SPENCER ST STE 2A
Manchester, CT 06040

(860) 791-8170

✔ PECOSSame address

Rushickah Brooks, MSN, APRN, FNP-C

Nurse Practitioner

NPI 1093267981

500 ALBANY AVE
Hartford, CT 06120

(860) 249-9625

✔ PECOS✔ Accepts Medicare6.2 mi

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 07D2220011

Innovative Healthcare Of Connecticut · Manchester, CT

Active · expires Apr 7, 2027

CLIA Number07D2220011

Laboratory TypePractitioner Other

Certificate Effective DateApril 8, 2025

Certificate Expiration DateApril 7, 2027

Laboratory DirectorCamylle Y. Appiahene

Laboratory Phone(860) 328-6147

Laboratory LocationInnovative Healthcare Of Connecticut112 Spencer Street, Suite 2A, Manchester, CT 06040

CLIA data matches this NPI record on: Address Name

This certificate is issued to a laboratory to perform only waived tests.

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 Innovative Healthcare Of Connecticut LLC's NPI number?

The NPI number for Innovative Healthcare Of Connecticut LLC is 1619567260. It was assigned to this organization in the NPPES registry on January 19, 2021.

Where is Innovative Healthcare Of Connecticut LLC located?

Innovative Healthcare Of Connecticut LLC is located at 112 Spencer St Ste 2A, Manchester, CT 06040. The listed phone number is (860) 791-8170.

What is Innovative Healthcare Of Connecticut LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Innovative Healthcare Of Connecticut LLC enrolled in Medicare?

Yes. Innovative Healthcare Of Connecticut LLC is registered in the Medicare PECOS enrollment system.

When is Innovative Healthcare Of Connecticut LLC's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Connecticut, Mass Immunization (Roster Biller Only)) is due for revalidation by October 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

How many clinicians bill Medicare through Innovative Healthcare Of Connecticut LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Innovative Healthcare Of Connecticut 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 2 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Innovative Healthcare Of Connecticut LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 07D2220011) is associated with this NPI, valid through April 7, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Innovative Healthcare Of Connecticut LLC was last updated on May 23, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.