Active NPI
Jeanette M Tetrault, MD
- Internal Medicine Physician
- New Haven, CT
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 042313
- Practice address
- 1 Long Wharf Dr
New Haven, CT 06511-5991 - Phone
- (203) 781-4600
- Fax
- (203) 781-4624
- NPI assigned
- Jul 12, 2006
- Last updated
- Jan 24, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 042313 | CT | Primary |
Addresses
Primary practice location
1 Long Wharf Dr
New Haven, CT 06511-5991
Mailing address
1 Long Wharf Dr
New Haven, CT 06511-5991
Phone (203) 781-4600
Other identifiers 15
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 008001325 | Medicaid | CT | |
| 500000315 | Medicaid | CT | |
| 001423136 | Medicaid | CT | |
| 008023170 | Medicaid | CT | |
| 008042339 | Medicaid | CT | |
| 008039745 | Medicaid | CT | |
| 004082286 | Medicaid | CT | |
| 008022622 | Medicaid | CT | |
| 008022626 | Medicaid | CT | |
| C01033 | Other | CT | MEDICARE PTAN |
| 004217099 | Medicaid | CT | |
| 008024427 | Medicaid | CT | |
| D400081097 | Other | CT | MEDICARE GROUP MEMBER PIN/PTAN |
| 004041000 | Medicaid | CT | |
| 004082260 | Medicaid | CT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Internal Medicine
- Education
- Boston University School of Medicine, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1 Long Wharf Dr
New Haven, CT 06511-5991
Phone (203) 781-4640
800 Howard Ave
New Haven, CT 06519-1369
Phone (203) 785-2140
Merit-based Incentive Payment System (MIPS)
- Final score
- 87.36 of 100
- Quality
- 77.36
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 74.27
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 042313 | CT | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Apt Foundation, Inc | Current | Accepting new patients | |
| Yale University | Internal Medicine | Current | Accepting new patients |
| Apt Foundation Inc | Current | Accepting new patients | |
| Yale University | Current | Accepting new patients | |
| Apt Foundation, Inc | Current | Accepting new patients | |
| Cornell Scott Hill Health Corporation | Current | Accepting new patients | |
| Franklin Medical Group, PC | Internal Medicine | Past | Accepting new patients |
Locations
1625 Straits Tpke
Middlebury, CT 06762
Phone (203) 759-0666
1625 Straits Tpke
Ste 201
Middlebury, CT 06762
Phone (203) 573-9512
1625 Straits Tpke
Ste 302
Middlebury, CT 06762
Phone (203) 759-0666
1 Long Wharf Dr
New Haven, CT 06511
Phone (203) 777-7500
1 Long Wharf Dr
Ste 321
New Haven, CT 06511
Phone (203) 781-4357
300 George St
Fl 6
New Haven, CT 06511
Phone (203) 785-6610
428 Columbus Ave
New Haven, CT 06519
Phone (203) 503-3228
800 Howard Ave
New Haven, CT 06519
Phone (203) 785-2140
Interoperability endpoints
- jtetrault47404@direct.ynhh.org
Organizations & group practices 7
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Yale Medicine
- Anesthesiology Physician
- New Haven, CT
- NPI 1205822236
Internal Medicine
-
- Federally Qualified Health Center (FQHC)
- New Haven, CT
- NPI 1902921380
-
- Durable Medical Equipment & Medical Supplies
- Fairfield, CT
- NPI 1548066962
-
dba Trinity Health Of New England Medical Group
- Internal Medicine Physician
- Waterbury, CT
- NPI 1780686964
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152662400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1642982400000",
"number": "1003841321",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 LONG WHARF DR",
"city": "NEW HAVEN",
"state": "CT",
"postal_code": "065115991",
"telephone_number": "203-781-4600",
"fax_number": "203-781-4624"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 LONG WHARF DR",
"city": "NEW HAVEN",
"state": "CT",
"postal_code": "065115991",
"telephone_number": "203-781-4600",
"fax_number": "203-781-4624"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TETRAULT",
"first_name": "JEANETTE",
"middle_name": "M",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-12",
"last_updated": "2022-01-24",
"certification_date": "2022-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CT",
"license": "042313",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "008001325",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500000315",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001423136",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "008023170",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "008042339",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "008039745",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004082286",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "008022622",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "008022626",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "C01033",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004217099",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "008024427",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP MEMBER PIN/PTAN",
"identifier": "D400081097",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004041000",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004082260",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}
Other providers in New Haven, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.