Individual provider Active NPI

Denise Lynn Kwiatkowski, PA

  • Medical Physician Assistant
  • Hartford, CT
National Provider Identifier
1134378722
Registry record updated Mar 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
002170 Issued in CT
Practice address
80 Seymour Street
Hartford Hospital Critical Care Medicine
Hartford, CT 06102-5037
Phone
(860) 545-5200
NPI assigned
Sep 18, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 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 002170 CT Primary

Addresses

Primary practice location

80 Seymour Street
Hartford Hospital Critical Care Medicine
Hartford, CT 06102-5037

Mailing address

PO Box 40,000 Dept 634
Hartford Hospital Professional Services
Hartford, CT 06151-0634
Phone (860) 545-7602

Other identifiers 1

IdentifierTypeStateIssuer
003021706MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20131007001015 MA Practitioner - Physician Assistant 6901969633 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Coastal Medical AssociatesGroup PAC ID 7113029257, 443 clinicians

Practice addresses (Care Compare)

55 Fogg Rd
Weymouth, MA 02190-2432
Phone (781) 792-4136

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
002170CTMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Steward Medical Group, Inc CurrentSince Feb 10, 2014 Accepting new patients
Steward Medical Group, Inc CurrentSince Feb 10, 2014 Accepting new patients
Medical Affiliates of Cape Cod, Inc. Past Accepting new patients

Locations

100 Amesbury St
Ste 103
Lawrence, MA 01840
Phone (978) 683-0157

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, 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": "1221696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616112000000",
    "number": "1134378722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40,000 DEPT 634",
            "address_2": "HARTFORD HOSPITAL PROFESSIONAL SERVICES",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061510634",
            "telephone_number": "860-545-7602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 SEYMOUR STREET",
            "address_2": "HARTFORD HOSPITAL CRITICAL CARE MEDICINE",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061025037",
            "telephone_number": "860-545-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KWIATKOWSKI",
        "first_name": "DENISE",
        "middle_name": "LYNN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-18",
        "last_updated": "2021-03-19",
        "certification_date": "2021-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "002170",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003021706",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hartford, CT

Sources for this page

Verify at the official NPI Registry.