Individual provider Active NPI

Victor Robert Quintanilla IV, P.A.

  • Surgical Physician Assistant
  • New Haven, CT
National Provider Identifier
1114053204
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
001468 Issued in CT
Practice address
1450 Chapel St
Department of Surgery
New Haven, CT 06511-4405
Phone
(203) 789-3501
NPI assigned
Feb 26, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 001468 CT Primary

Addresses

Primary practice location

1450 Chapel St
Department of Surgery
New Haven, CT 06511-4405

Mailing address

640 Mix Ave
Apt#3E
Hamden, CT 06514-2352
Phone (203) 288-2385

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
I20040625000705 CT Practitioner - Physician Assistant 8224014741 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Yale University School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

300 George St
FL 6
New Haven, CT 06511-6624

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.36 of 100Reported as group
Quality
77.36
Promoting interoperability
100
Improvement activities
40
Cost
74.27

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
001468CTMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Northeast Medical Group, Inc. CurrentSince Sep 12, 2012 Accepting new patients
Mill Hill Medical Consultants Inc CurrentSince Sep 12, 2012 Accepting new patients
Saint Raphael Healthcare System Affiliated Physicians Inc Past Accepting new patients
Saint Raphael Faculty Physicians Past Accepting new patients

Locations

1354 Chapel St
New Haven, CT 06511
Phone (203) 867-8300

1450 Chapel St
New Haven, CT 06511
Phone (203) 789-3151

300 George St
Fl 6
New Haven, CT 06511
Phone (203) 785-6610

800 Howard Ave
New Haven, CT 06519
Phone (203) 785-2140

95 Armory Rd
Stratford, CT 06614
Phone (203) 384-3388

Interoperability endpoints

  • Direct secure messaging: vquintanilla100282@direct.ynhh.org

Organizations & group practices 4

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

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": "1172448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1114053204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 MIX AVE",
            "address_2": "APT#3E",
            "city": "HAMDEN",
            "state": "CT",
            "postal_code": "065142352",
            "telephone_number": "203-288-2385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 CHAPEL ST",
            "address_2": "DEPARTMENT OF SURGERY",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065114405",
            "telephone_number": "203-789-3501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUINTANILLA",
        "first_name": "VICTOR",
        "middle_name": "ROBERT",
        "name_prefix": "Mr.",
        "name_suffix": "IV",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CT",
            "license": "001468",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Haven, CT

Sources for this page

Verify at the official NPI Registry.