Individual provider Active NPI

Jessica L Gumula

  • Certified Registered Nurse Anesthetist
  • New Britain, CT
National Provider Identifier
1063880516
Registry record updated Sep 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
89088 Issued in CT
Practice address
100 Grand St
New Britain, CT 06052-2016
Phone
(860) 224-5011
NPI assigned
Sep 14, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 089088 CT
Certified Registered Nurse Anesthetist 367500000X 89088 CT Primary

Addresses

Primary practice location

100 Grand St
New Britain, CT 06052-2016

Mailing address

11781 Lee Jackson Memorial Hwy
Ste 550
Fairfax, VA 22033-3309
Phone (571) 777-5164

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151117001170 CT Practitioner - Certified Registered Nurse Anesthetist (Crna) 9032429386 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Integrated Anesthesia Associates LLCGroup PAC ID 1759281165, 402 clinicians

Practice addresses (Care Compare)

1312 W Main St
Dba Waterbury Surgery Center
Waterbury, CT 06708-3121
Phone (860) 282-0833

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.99 of 100Reported as group
Quality
89.16
Promoting interoperability
100
Improvement activities
40
Cost
78.45

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
089088CTMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Endoscopy Center of Connecticut, LLC CurrentSince Nov 7, 2016 Accepting new patients
Endoscopy Center of Connecticut, LLC Current Accepting new patients
North American Partners in Anesthesia Connecticut PC CurrentSince Dec 1, 2015 Accepting new patients
Connecticut Gi PLLC CurrentSince Feb 19, 2018 Accepting new patients
Integrated Anesthesia Associates LLC Nurse Anesthetist, Certified Registered CurrentSince Nov 1, 2019 Accepting new patients

Locations

2200 Whitney Ave
Ste 380
Hamden, CT 06518
Phone (203) 281-3636

80 Seymour St
Hartford, CT 06106
Phone (860) 545-2249

99 E River Dr
Fl 5
Hartford, CT 06108
Phone (860) 282-4022

85 Seymour St
Ste 1000
Hartford, CT 06106
Phone (860) 246-2571

100 Grand St
New Britain, CT 06052
Phone (860) 224-5011

30 Waterchase Dr
Rocky Hill, CT 06067
Phone (860) 257-4131

2 Corporate Dr
Ste 955
Shelton, CT 06484
Phone (203) 929-7375

1312 W Main St
Waterbury, CT 06708
Phone (203) 709-4575

Organizations & group practices 5

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.

Hospital & facility affiliations 2

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": "1442188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443571200000",
    "number": "1063880516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11781 LEE JACKSON MEMORIAL HWY",
            "address_2": "STE 550",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220333309",
            "telephone_number": "571-777-5164",
            "fax_number": "703-890-2650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 GRAND ST",
            "city": "NEW BRITAIN",
            "state": "CT",
            "postal_code": "060522016",
            "telephone_number": "860-224-5011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUMULA",
        "first_name": "JESSICA",
        "middle_name": "L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-14",
        "last_updated": "2015-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CT",
            "license": "089088",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "CT",
            "license": "89088",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Britain, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.