Collaborative Medicine LLC
NPI 1063137511ActiveOrganization· Nurse Practitioner, Family· Canton, CT
Nurse Practitioner, Family in Canton, Connecticut, registered in NPPES in October 2022. The authorized official on file is Jennifer Cannon, NP-C, Owner. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1063137511 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Oct 6, 2022 |
| Last updated in NPPES | May 22, 2025 |
| Certified by provider | May 22, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Nurse Practitioner, Family Primary | 363LF0000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (CT) |
|---|
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