# PRISM SPORTS MEDICINE, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851920029
- **Authorized official:** CARL NISSEN MD (OWNER)
- **Authorized official phone:** (860) 282-4128

## Contact information

- **Practice address:** 31 SEYMOUR ST STE 204, HARTFORD, CT 06106-5505
- **Practice address phone:** (860) 421-3233
- **Mailing address:** 31 PINNACLE RIDGE RD, FARMINGTON, CT 06032-3041
- **Mailing address phone:** (860) 421-3233

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 207XX0005X | Sports Medicine (Orthopaedic Surgery) Physician | — | NULL | — |
| 207XX0005X | Sports Medicine (Orthopaedic Surgery) Physician | — | — | — |

## Other

- **Enumeration date:** 04/08/2020
- **Last updated:** 11/19/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00000000 | — | CT |