Peter Pegolo, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

CT02448 Issued in CT

Practice address

612 Quaker LN S
Suite B
West Hartford, CT 06110-1027

Phone

(860) 236-1218

Fax

(860) 231-9298

NPI assigned

Aug 30, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 8

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

New England College of Optometry, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Optometric Specialty Group of Simsbury PLLC

  • Optometrist
  • Simsbury, CT
  • NPI 1457085722
  Medicare reassignment NPD Authorized official
• Optometric Specialty Group of Wethersfield, PLLC

  • Optometrist
  • Wethersfield, CT
  • NPI 1629561428
  Medicare reassignment NPD Authorized official
• Optometric Specialty Group Limited Liability Company

  • Optometrist
  • West Hartford, CT
  • NPI 1184717365
  Medicare reassignment NPD

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343260800000",
    "number": "1184733255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 QUAKER LN S",
            "address_2": "SUITE B",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061101027",
            "telephone_number": "860-236-1218",
            "fax_number": "860-231-9298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 QUAKER LN S",
            "address_2": "SUITE B",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061101027",
            "telephone_number": "860-236-1218",
            "fax_number": "860-231-9298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEGOLO",
        "first_name": "PETER",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2012-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CT",
            "license": "CT02448",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET",
            "identifier": "2V5586",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5094583",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONNECTICARE",
            "identifier": "002448",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "090002448CT02",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "1749886",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "203912450",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VISION SERVICE PLAN",
            "identifier": "203912450",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "522108187187",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pediatric and Adolescent Speech Therapy Associates
• Pediatric Ear, Nose & Throat Associates, P.C.
• Pedicorp, PC
• Elyse Pedra, LPC-A
• Melanie Peele, MED, MA, LPC
• Emily Bevelaqua Pellegrino
• Brian Pelletier, PHARM.D.
• Cara Pelletier, FNP-C
• Elizabeth Pelletier, APRN
• People'S Dental

• Optometrist in West Hartford, CT
• Providers in West Hartford, CT by specialty
• Optometrist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.