Kettly Cassamajor

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

12.006973 Issued in CT

Practice address

4920 Main St Ste 302
Bridgeport, CT 06606-1300

Phone

(475) 210-4960

Fax

(203) 371-0542

NPI assigned

Mar 22, 2017

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Hartford Healthcare Medical Group Specialists PLLCGroup PAC ID 3173866241, 1,555 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

90.42 of 100Reported as group

Quality

83.36

Promoting interoperability

100

Improvement activities

40

Cost

75.9

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kettly.cassamajor@xdr.hhchealthdirect.org

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.

• Hartford Healthcare Medical Group Specialists, PLLC

  • Surgery Physician
  • Hartford, CT
  • NPI 1023584216
  Medicare reassignment Care Compare group NPD
• Jack V. Diteodoro M.D,LLC

  • Point of Service
  • Stamford, CT
  • NPI 1700194636
  Medicare reassignment NPD
• Optimus Health Care Inc

  • Federally Qualified Health Center (FQHC)
  • Bridgeport, CT
  • NPI 1669445946
  Medicare reassignment NPD
• Stella Medical Care LLC

  • Adult Health Nurse Practitioner
  • Stamford, CT
  • NPI 1255851481
  Medicare reassignment NPD
• Hartford Healthcare Medical Group Specialists LLC

  • Customized Equipment (DME)
  • Groton, CT
  • NPI 1295367068
  NPD
• Optimus Health Care Inc

  • Federally Qualified Health Center (FQHC)
  • Stratford, CT
  • NPI 1922378496
  NPD (past)

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

{
    "created_epoch": "1490140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678320000000",
    "number": "1235660267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1290 SILAS DEANE HWY",
            "address_2": "HARTFORD HEALTHCARE-CVO",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061094337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4920 MAIN ST STE 302",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066061300",
            "telephone_number": "475-210-4960",
            "fax_number": "203-371-0542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CASSAMAJOR",
        "first_name": "KETTLY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-03-22",
        "last_updated": "2023-03-09",
        "certification_date": "2023-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "12.006973",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004234788",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kerry Carton-Milner
• Veronica Carvajal
• James Caserta, DDS
• Robert A Caserta, MD
• Tamika Cash
• Roberto J Castellon-Teran, LCSW
• Luis Alejandro Castellon Jr., BS
• Jairo Castillo, MD
• Karla Castillo
• Simon Andres Castro Montenegro, MD

• Family Nurse Practitioner in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Family Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2023; 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.