BRISTOL HOSPITAL MULTI SPECIALTY GROUP, INC – General Practice Physician, NPI 1649265679
General Practice Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for BRISTOL HOSPITAL MULTI SPECIALTY GROUP, INC
Bristol Post Office, Crumley Alley, Bristol, Sullivan County, East Tennessee, Tennessee, 24201, United States
BRISTOL, CT 060112828
Phone: (860) 585-3906
Fax: (860) 585-3907
Type: Mailing
15 RIVERSIDE AVE
BRISTOL, CT 060106312
Phone: (860) 585-3906
Fax: (860) 585-3907
Type: Location
923, Farmington Avenue, Bristol, Naugatuck Valley Planning Region, Connecticut, 06010, United States
BRISTOL, CT 060103927
Phone: (860) 585-3906
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2024-11-26
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20031204000960 | O | Clinic/Group Practice | CT | TBD |
| O20241126001628 | O | Physician - Orthopedic/Orthopedic Surgery | CT | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 06011)
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