Individual provider Active NPI

Blerina Petitti, APRN

  • Primary Care Nurse Practitioner
  • Naugatuck, CT
National Provider Identifier
1073290441
Registry record updated Aug 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
12220 Issued in CT
Practice address
131 Bridge St
Naugatuck, CT 06770-2929
Phone
(203) 729-0755
Fax
(203) 729-0797
NPI assigned
Jun 28, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2023

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 143852 CT
Primary Care Nurse Practitioner 363LP2300X 12220 CT Primary

Addresses

Primary practice location

131 Bridge St
Naugatuck, CT 06770-2929

Mailing address

67 Maple Ave
Derby, CT 06418-1328

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
I20230829000376 CT Practitioner - Nurse Practitioner 5698138378 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Griffin Faculty Physicians IncGroup PAC ID 7618871997, 125 clinicians

Practice addresses (Care Compare)

130 Division St
Derby, CT 06418-1326
Phone (203) 732-1352

Hospital & facility affiliations

  • Elara Caring Home health agency, Rocky Hill, CT, CCN 077163
  • Griffin Hospital Hospital, Derby, CT, CCN 070031

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
143852CTMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Griffin Faculty Physicians, Inc. CurrentSince Sep 1, 2023 Accepting new patients
Internal Medicine & Pediatrics LLC PastSince Aug 27, 2023 Accepting new patients

Locations

67 Maple Ave
Derby, CT 06418
Phone (203) 732-0699

130 Division St
Derby, CT 06418
Phone (203) 732-1330

131 Bridge St
Naugatuck, CT 06770
Phone (203) 729-0755

Interoperability endpoints

  • Direct secure messaging: blerina.petitti.1@1323.direct.athenahealth.com

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.

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": "1687910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691971200000",
    "number": "1073290441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 MAPLE AVE",
            "city": "DERBY",
            "state": "CT",
            "postal_code": "064181328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 BRIDGE ST",
            "city": "NAUGATUCK",
            "state": "CT",
            "postal_code": "067702929",
            "telephone_number": "203-729-0755",
            "fax_number": "203-729-0797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETITTI",
        "first_name": "BLERINA",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-28",
        "last_updated": "2023-08-14",
        "certification_date": "2023-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CT",
            "license": "143852",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "CT",
            "license": "12220",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Naugatuck, CT

Sources for this page

Verify at the official NPI Registry.