Jackilyn Annelli, PA
Individual provider Active NPI Rheumatology Physician · Norwich, CT
NPI 1245085315 · NPPES record last updated Apr 22, 2024
Key facts
- NPI
- 1245085315
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Rheumatology Physician 207RR0500X
- License
- 6548 (CT)
- Practice address
- 12 Case St Ste 212
Norwich, CT 06360-2222 - Phone
- (860) 859-9123
- Fax
- (860) 859-9124
- NPI assigned
- Apr 22, 2024
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 12
Hospital & facility affiliations 8
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- New England Rheumatology LLC
Ptsma Inc
Practice addresses (Care Compare)
12 Case St
Suite 212
Norwich, CT 06360-2222
Phone (860) 859-9123
37 S Broad St
Unit 12
Pawcatuck, CT 06379-7909
Phone (860) 495-1919
Hospital & facility affiliations
- Lawrence & Memorial Hospital
- William W Backus Hospital
- Day Kimball Hospital
- Middlesex Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240522000074 | CT | Practitioner - Physician Assistant | 9436591500 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6548 | CT | MD | Clinical Social Worker |
Interoperability endpoints
- jackilyn.anneli@xdr.hhchealthdirect.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rheumatology Physician |
207RR0500X | 6548 | CT | Yes |
Addresses
Primary practice location
12 Case St Ste 212
Norwich, CT 06360-2222
Mailing address
12 Case St Ste 212
Norwich, CT 06360-2222
Phone (860) 859-9123
Other providers in Norwich, CT
- Christine Anderson
- Nancy Anderson
- Sophia Elizabeth Andrew
- Katherine Andrias
- Larisa Anisimov
- Sherida Antonacci
- Maria Aponte
- James W Aree
- Amanda Armstrong
- Lexus Arvanis
All providers in Norwich, CT · Rheumatology Physician in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 22, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.