Individual provider Active NPI

Jeanette M Tetrault, MD

  • Internal Medicine Physician
  • New Haven, CT
National Provider Identifier
1003841321
Registry record updated Jan 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
042313 Issued in CT
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, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
008001325MedicaidCT
500000315MedicaidCT
001423136MedicaidCT
008023170MedicaidCT
008042339MedicaidCT
008039745MedicaidCT
004082286MedicaidCT
008022622MedicaidCT
008022626MedicaidCT
C01033OtherCTMEDICARE PTAN
004217099MedicaidCT
008024427MedicaidCT
D400081097OtherCTMEDICARE GROUP MEMBER PIN/PTAN
004041000MedicaidCT
004082260MedicaidCT

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041123000765 CT Practitioner - Internal Medicine 5294714507 Reassigns benefits to 3 organizations

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
Apt Foundation, IncGroup PAC ID 8729250204, 13 clinicians
Yale UniversityGroup PAC ID 9436061736, 2,632 clinicians

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 100Reported as group
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

LicenseStateTypeSpecialty
042313CTMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Apt Foundation, Inc CurrentSince Jun 4, 2012 Accepting new patients
Yale University Internal Medicine CurrentSince Jul 1, 2014 Accepting new patients
Apt Foundation Inc CurrentSince Jul 1, 2025 Accepting new patients
Yale University CurrentSince Jul 1, 2014 Accepting new patients
Apt Foundation, Inc CurrentSince Jun 4, 2012 Accepting new patients
Cornell Scott Hill Health Corporation CurrentSince Nov 11, 2020 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

  • Direct secure messaging: 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.

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

Verify at the official NPI Registry.