Individual provider Active NPI

Jillian P Sipperly

  • Certified Registered Nurse Anesthetist
  • West Hartford, CT
National Provider Identifier
1205405693
Registry record updated May 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
9745 Issued in CT
Practice address
1093 Prospect Ave
West Hartford, CT 06105-1104
Phone
(860) 977-4878
NPI assigned
Jun 21, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 31, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 9745 CT Primary

Addresses

Primary practice location

1093 Prospect Ave
West Hartford, CT 06105-1104

Mailing address

151 N Main St # 4026
Bristol, CT 06010-9992
Phone (860) 977-4878

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT, HI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210716000909 CT Practitioner - Certified Registered Nurse Anesthetist (Crna) 3274935978 Reassigns benefits to 3 organizations
I20240415003621 HI Practitioner - Certified Registered Nurse Anesthetist (Crna) 3274935978 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pacific Anesthesia IncGroup PAC ID 1951596329, 108 clinicians
Charter Anesthesiology LLCGroup PAC ID 2163763830, 34 clinicians

Practice addresses (Care Compare)

1301 Punchbowl St
Honolulu, HI 96813-2402
Phone (808) 691-1000

41 Brewster Rd
Bristol, CT 06010-5161
Phone (800) 585-3000

Hospital & facility affiliations

  • Bristol Hospital Hospital, Bristol, CT, CCN 070029
  • The Queens Medical Center Hospital, Honolulu, HI, CCN 120001

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Charter Anesthesiology LLC Anesthesiology CurrentSince Jun 12, 2021 Accepting new patients
Woodland Anesthesia Associates PC Anesthesiology CurrentSince Jul 1, 2021 Accepting new patients
Connecticut Gi PLLC CurrentSince Oct 1, 2022 Accepting new patients
Pacific Anesthesia, Inc Anesthesiology CurrentSince May 1, 2024 Accepting new patients

Locations

701 Cottage Grove Rd
Ste F230
Bloomfield, CT 06002
Phone (860) 243-5569

41 Brewster Rd
Bristol, CT 06010
Phone (800) 585-3000

85 Seymour St
Ste 1000
Hartford, CT 06106
Phone (860) 246-2571

114 Woodland St
Hartford, CT 06105
Phone (860) 714-4001

30 Waterchase Dr
Rocky Hill, CT 06067
Phone (860) 257-4131

245 Alvord Park Rd
Bldg B
Torrington, CT 06790
Phone (860) 482-4866

1301 Punchbowl St
Honolulu, HI 96813
Phone (808) 538-9011

321 N Kuakini St
Ste 306
Honolulu, HI 96817
Phone (808) 545-1557

Organizations & group practices 4

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.

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": "1624233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717113600000",
    "number": "1205405693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 N MAIN ST # 4026",
            "city": "BRISTOL",
            "state": "CT",
            "postal_code": "060109992",
            "telephone_number": "860-977-4878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1093 PROSPECT AVE",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061051104",
            "telephone_number": "860-977-4878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIPPERLY",
        "first_name": "JILLIAN",
        "middle_name": "P",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-21",
        "last_updated": "2024-05-31",
        "certification_date": "2024-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "CT",
            "license": "9745",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Hartford, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.