Active NPI
Jessica Vaz Martins, PA-C
- Surgical Physician Assistant
- Trumbull, CT
National Provider Identifier
1053628784
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 002445
- Practice address
- 160 Hawley LN Ste 2
Trumbull, CT 06611-5387 - Phone
- (203) 375-3456
- Fax
- (203) 380-3803
- NPI assigned
- Sep 1, 2010
- 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 |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 002445 | CT | Primary |
Addresses
Primary practice location
160 Hawley LN Ste 2
Trumbull, CT 06611-5387
Mailing address
160 Hawley Lane
Ste 002
Trumbull, CT 06611
Phone (203) 375-3456
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110110000137 | CT | Practitioner - Physician Assistant | 6608065461 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Northeast Medical Group Inc
Practice addresses (Care Compare)
95 Armory Rd
Stratford, CT 06614-1702
Phone (203) 384-3388
Hospital & facility affiliations
- Bridgeport Hospital
- Yale-New Haven Hospital
- Greenwich Hospital Association -
Merit-based Incentive Payment System (MIPS)
- Final score
- 100 of 100
- Quality
- 86.54
- Promoting interoperability
- 99.98
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002445 | CT | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northeast Medical Group, Inc. | Current | Accepting new patients | |
| Northeast Medical Group Inc | Current | Accepting new patients |
Locations
2800 Main St
Bridgeport, CT 06606
Phone (203) 386-0366
52 Beach Rd
Ste 102
Fairfield, CT 06824
Phone (203) 256-9905
95 Armory Rd
Stratford, CT 06614
Phone (203) 384-3388
160 Hawley Ln
Ste 2
Trumbull, CT 06611
Phone (203) 375-3456
Interoperability endpoints
- jmartins318868@direct.ynhh.org
Organizations & group practices 2
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.
-
- Radiation Oncology Physician
- Greenwich, CT
- NPI 1821390626
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1283299200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1498521600000",
"number": "1053628784",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "160 HAWLEY LANE",
"address_2": "STE 002",
"city": "TRUMBULL",
"state": "CT",
"postal_code": "06611",
"telephone_number": "203-375-3456",
"fax_number": "203-380-3803"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "160 HAWLEY LN STE 2",
"city": "TRUMBULL",
"state": "CT",
"postal_code": "066115387",
"telephone_number": "203-375-3456",
"fax_number": "203-380-3803"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTINS",
"first_name": "JESSICA",
"middle_name": "VAZ",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-09-01",
"last_updated": "2017-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "CT",
"license": "002445",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Trumbull, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2017; 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.