Individual provider Active NPI

Anna Jeanne Ciccolini, PA-C

  • Medical Physician Assistant
  • Garner, NC
National Provider Identifier
1104925254
Registry record updated Dec 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
0010-09323 Issued in NC
Practice address
811 US 70 Hwy W
Garner, NC 27529-2541
Phone
(919) 235-6565
Fax
(919) 235-6596
NPI assigned
Sep 22, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 0010-09323 NC Primary

Addresses

Primary practice location

811 US 70 Hwy W
Garner, NC 27529-2541

Mailing address

2920 Highwoods Blvd
Raleigh, NC 27604-0010
Phone (877) 498-4490

Other names 1

  • Anna J. Bosso Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address aciccolini312583@directHISP.wakemed.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20200602002331 NC Practitioner - Physician Assistant 7315945433 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
State University of New York at Stony Brook, School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wakemed Specialists Group LLCGroup PAC ID 2466788377, 868 clinicians

Practice addresses (Care Compare)

3000 New Bern Ave
Raleigh, NC 27610-1231
Phone (919) 350-7270

Hospital & facility affiliations

  • Wakemed, Raleigh Campus Hospital, Raleigh, NC, CCN 340069

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Middlesex Hospital CurrentSince Jul 1, 2016 Accepting new patients
Middlesex Hospital CurrentSince Jul 1, 2016 Accepting new patients
Hartford Pathology Associates, P.C. Current Accepting new patients
Wakemed Specialists Group LLC CurrentSince Jul 6, 2020 Accepting new patients
Hartford Healthcare Medical Group, Inc Physician Assistant CurrentSince Apr 1, 2016 Accepting new patients
Hartford Hospital CurrentSince Jun 9, 2008 Accepting new patients
Wakemed Specialists Group, LLC CurrentSince Jul 6, 2020 Accepting new patients
Connecticut Urgent Care Centers, LLC Physician Assistant Past Accepting new patients

Locations

385 W Main St
Avon, CT 06001
Phone (860) 777-1280

80 S Main St
Ste 102
Middletown, CT 06457
Phone (860) 358-6878

28 Crescent St
Middletown, CT 06457
Phone (860) 358-6000

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

55 Meriden Ave
Ste 1D
Southington, CT 06489
Phone (860) 276-5144

540 Litchfield St
Torrington, CT 06790
Phone (860) 496-6361

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

112 Mansfield Ave
Willimantic, CT 06226
Phone (830) 423-6410

811 US 70 Hwy W
Garner, NC 27529
Phone (919) 235-6565

3000 New Bern Ave
Raleigh, NC 27610
Phone (919) 350-7000

2920 Highwoods Blvd
Raleigh, NC 27604

Interoperability endpoints

  • Direct secure messaging: aciccolini312583@directhisp.wakemed.org

Organizations & group practices 9

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": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638835200000",
    "number": "1104925254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2920 HIGHWOODS BLVD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276040010",
            "telephone_number": "877-498-4490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 US 70 HWY W",
            "city": "GARNER",
            "state": "NC",
            "postal_code": "275292541",
            "telephone_number": "919-235-6565",
            "fax_number": "919-235-6596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CICCOLINI",
        "first_name": "ANNA",
        "middle_name": "JEANNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-22",
        "last_updated": "2021-12-07",
        "certification_date": "2021-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "0010-09323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "aciccolini312583@directHISP.wakemed.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "XML",
            "address_1": "811 US 70 Hwy W",
            "city": "Garner",
            "state": "NC",
            "country_code": "US",
            "postal_code": "275292541",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ANNA",
            "last_name": "BOSSO",
            "middle_name": "J.",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Garner, NC

Sources for this page

Verify at the official NPI Registry.