Individual provider Active NPI

Marta Fedorko

  • Nurse Practitioner
  • Meriden, CT
National Provider Identifier
1043944358
Registry record updated Aug 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
13285 Issued in CT
Practice address
435 Lewis Ave
Meriden, CT 06451-2101
Phone
(203) 694-8200
NPI assigned
Jul 12, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 13285 CT Primary

Addresses

Primary practice location

435 Lewis Ave
Meriden, CT 06451-2101

Mailing address

435 Lewis Ave
Meriden, CT 06451-2101

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241017001389 CT Practitioner - Nurse Practitioner 5496287237 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
13285CTMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Midstate Medical Center Current Accepting new patients
Midstate Medical Center CurrentSince Oct 1, 2024 Accepting new patients
Midstate Medical Center CurrentSince Oct 1, 2024 Accepting new patients

Locations

2800 Main St
Bridgeport, CT 06606
Phone (203) 386-0366

435 Lewis Ave
Meriden, CT 06451
Phone (203) 284-1340

1290 Silas Deane Hwy
Wethersfield, CT 06109
Phone (860) 972-6977

Interoperability endpoints

  • Direct secure messaging: marta.fedorko@xdr.hhchealthdirect.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1657584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724025600000",
    "number": "1043944358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "435 LEWIS AVE",
            "city": "MERIDEN",
            "state": "CT",
            "postal_code": "064512101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 LEWIS AVE",
            "city": "MERIDEN",
            "state": "CT",
            "postal_code": "064512101",
            "telephone_number": "203-694-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEDORKO",
        "first_name": "MARTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-12",
        "last_updated": "2024-08-19",
        "certification_date": "2024-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CT",
            "license": "13285",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meriden, CT

Sources for this page

Verify at the official NPI Registry.