NPIMap

Individual provider Active NPI

Marlie Dana Schmidt, PA

  • Physician Assistant
  • Manchester, CT
National Provider Identifier
1235449638
Registry record updated Jun 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
002418 Issued in CT
Practice address
71 Haynes St
Eastern Connecticut Health Network
Manchester, CT 06040-4131
Phone
(860) 647-6475
NPI assigned
Oct 19, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 0049093 CT
Physician Assistant 363A00000X 002418 CT Primary

Addresses

Primary practice location

71 Haynes St
Eastern Connecticut Health Network
Manchester, CT 06040-4131

Mailing address

71 Haynes St
Eastern Connecticut Health Network
Manchester, CT 06040-4131
Phone (860) 647-6475

Other identifiers 1

IdentifierTypeStateIssuer
003024189MedicaidCT

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110212000032 CT Practitioner - Physician Assistant 8628258399 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Urgent Care Medical Associates, LLCGroup PAC ID 7214107515, 113 clinicians

Practice addresses (Care Compare)

21 -B Killingworth Turnpike
Clinton, CT 06413
Phone (959) 356-2106

Hospital & facility affiliations

  • Yale-New Haven Hospital Hospital, New Haven, CT, CCN 070022

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
002418CTMDClinical Psychologist
0049093CTMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Prospect Manchester Hospital, Inc. CurrentSince Nov 8, 2023 Accepting new patients
Prospect Manchester Hospital, Inc. CurrentSince Nov 8, 2023 Accepting new patients
Lawrence and Memorial Hospital, Inc. CurrentSince Dec 8, 2020 Accepting new patients
Lawrence and Memorial Hospital, Inc. Physician Assistant CurrentSince Dec 8, 2020 Accepting new patients
Urgent Care Medical Associates, LLC Physician Assistant CurrentSince Dec 1, 2025 Accepting new patients
WRK Ventures, LLC Past Accepting new patients
Eastern Connecticut Medical Professionals Foundation, Inc Past Accepting new patients
Eastern Connecticut Medical Professionals Foundation Inc Medical Past Accepting new patients

Locations

21B Killingworth Tpke
Clinton, CT 06413
Phone (959) 356-2106

320 Main St
Manchester, CT 06040

71 Haynes St
Manchester, CT 06040
Phone (860) 533-2981

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

2600 Tamarack Ave
South Windsor, CT 06074
Phone (860) 872-0501

900 Main St S
Ste 100
Southbury, CT 06488
Phone (203) 262-1911

31 Union St
Vernon Rockvl, CT 06066
Phone (860) 289-6451

Organizations & group practices 10

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": "1287446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370563200000",
    "number": "1235449638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "71 HAYNES ST",
            "address_2": "EASTERN CONNECTICUT HEALTH NETWORK",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060404131",
            "telephone_number": "860-647-6475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "71 HAYNES ST",
            "address_2": "EASTERN CONNECTICUT HEALTH NETWORK",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060404131",
            "telephone_number": "860-647-6475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHMIDT",
        "first_name": "MARLIE",
        "middle_name": "DANA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-19",
        "last_updated": "2013-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "0049093",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "002418",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003024189",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, CT

Sources for this page

Verify at the official NPI Registry.