Individual provider Active NPI

Carly Beth Roy, PA

  • Physician Assistant
  • Farmington, CT
National Provider Identifier
1144733866
Registry record updated Jan 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3932 Issued in CT
Practice address
263 Farmington Ave
Farmington, CT 06030-0001
Phone
(860) 679-2000
NPI assigned
Nov 16, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 3932 CT Primary

Addresses

Primary practice location

263 Farmington Ave
Farmington, CT 06030-0001

Mailing address

28 Spice Hill Dr
East Hampton, CT 06424-1760
Phone (860) 338-1050

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address croy10968@direct.med.uchc.edu

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20241010001530 CA Practitioner - Physician Assistant 1759649676 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Omar Osman Practice, LLCGroup PAC ID 4385014042, 45 clinicians

Practice addresses (Care Compare)

5602 University Ave
San Diego, CA 92105-2308
Phone (619) 583-1993

7160 Fay Ave
La Jolla, CA 92037-5511
Phone (858) 459-4361

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
64506CAMDPharmacist
3932CTMDOccupational Therapist

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1510790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673568000000",
    "number": "1144733866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 SPICE HILL DR",
            "city": "EAST HAMPTON",
            "state": "CT",
            "postal_code": "064241760",
            "telephone_number": "860-338-1050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "263 FARMINGTON AVE",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060300001",
            "telephone_number": "860-679-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROY",
        "first_name": "CARLY",
        "middle_name": "BETH",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-11-16",
        "last_updated": "2023-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "3932",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "croy10968@direct.med.uchc.edu",
            "affiliation": "N",
            "address_1": "Uconn Medical Group",
            "address_2": "263 Farmington Avenue",
            "city": "Farmington",
            "state": "CT",
            "country_code": "US",
            "postal_code": "060300001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Farmington, CT

Sources for this page

Verify at the official NPI Registry.