Individual provider Active NPI

James William Pellegrini, M.D.

  • Neonatal-Perinatal Medicine Physician
  • New London, CT
National Provider Identifier
1184685331
Registry record updated Jul 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
69234 Issued in CT
Practice address
365 Montauk Ave
New London, CT 06320-4769
Phone
(860) 444-5151
NPI assigned
Mar 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neonatal-Perinatal Medicine Physician 2080N0001X 70290 MA
Neonatal-Perinatal Medicine Physician 2080N0001X 69234 CT Primary

Addresses

Primary practice location

365 Montauk Ave
New London, CT 06320-4769

Mailing address

365 Montauk Ave
New London, CT 06320-4769
Phone (860) 444-5151

Other practice location 1

1 Park Ave
New Haven, CT 06517-1932
Phone (203) 688-4242

Other identifiers 1

IdentifierTypeStateIssuer
3100936MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, CT2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20050511000149 MA Practitioner - Pediatric Medicine 5890735633
I20210907000940 CT Practitioner - Pediatric Medicine 5890735633 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
69234CTMDNeonatal-Perinatal Medicine Physician
70290MAMDNeonatal-Perinatal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Yale University CurrentSince Aug 19, 2021 Accepting new patients
Yale University CurrentSince Aug 19, 2021 Accepting new patients
Yale University Current Accepting new patients

Locations

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

50 Division St
New Haven, CT 06511
Phone (203) 785-2140

365 Montauk Ave
New London, CT 06320
Phone (860) 271-4364

1 Park St
North Haven, CT 06504
Phone (203) 785-4643

Interoperability endpoints

  • Direct secure messaging: jpellegrini37663@direct.southcoast.org
  • Direct secure messaging: jpellegrini527053@direct.ynhh.org

Organizations & group practices 3

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": "1143590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627516800000",
    "number": "1184685331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "365 MONTAUK AVE",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063204769",
            "telephone_number": "860-444-5151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "365 MONTAUK AVE",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063204769",
            "telephone_number": "860-444-5151"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Park Ave",
            "address_purpose": "LOCATION",
            "city": "New Haven",
            "state": "CT",
            "postal_code": "065171932",
            "country_code": "US",
            "telephone_number": "203-688-4242",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PELLEGRINI",
        "first_name": "JAMES",
        "middle_name": "WILLIAM",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-29",
        "last_updated": "2021-07-29",
        "certification_date": "2021-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "MA",
            "license": "70290",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "CT",
            "license": "69234",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3100936",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New London, CT

Sources for this page

Verify at the official NPI Registry.