Individual provider Active NPI

Dara Manness

  • Nurse Practitioner
  • West Hartford, CT
National Provider Identifier
1124798400
Registry record updated Aug 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
12198 Issued in CT
Practice address
275 Steele Rd
West Hartford, CT 06117-2716
Phone
(860) 570-8200
NPI assigned
Sep 17, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 143291 CT
Student in an Organized Health Care Education/Training Program 390200000X
Nurse Practitioner 363L00000X 12198 CT Primary

Addresses

Primary practice location

275 Steele Rd
West Hartford, CT 06117-2716

Mailing address

2 Old Farms Rd
West Suffield, CT 06093-2829
Phone (860) 670-7067

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
I20230906002077 CT Order and Referring Only - Nurse Practitioner 3173987369

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
143291CTMDRegistered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1631836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691280000000",
    "number": "1124798400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 OLD FARMS RD",
            "city": "WEST SUFFIELD",
            "state": "CT",
            "postal_code": "060932829",
            "telephone_number": "860-670-7067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 STEELE RD",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061172716",
            "telephone_number": "860-570-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANNESS",
        "first_name": "DARA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-17",
        "last_updated": "2023-08-06",
        "certification_date": "2023-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CT",
            "license": "143291",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CT",
            "license": "12198",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Hartford, CT

Sources for this page

Verify at the official NPI Registry.