Lissette I Cruz, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

003107 Issued in CT

Practice address

64 Black Rock Ave
Bridgeport, CT 06605-1200

Phone

(203) 579-5000

Fax

(203) 579-5113

NPI assigned

Jul 21, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Physician Assistant

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Optimus Health Care IncGroup PAC ID 9335051580, 79 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Bridgeport Hospital Hospital, Bridgeport, CT, CCN 070010

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lcruz320512@direct.ynhh.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.

• Optimus Health Care Inc

  • Federally Qualified Health Center (FQHC)
  • Bridgeport, CT
  • NPI 1669445946
  Medicare reassignment Care Compare group NPD
• Optimus Health Care Inc

  • Federally Qualified Health Center (FQHC)
  • Bridgeport, CT
  • NPI 1346516317
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Bridgeport Hospital

  • General Acute Care Hospital
  • Bridgeport, CT
  • NPI 1649260845
  Care Compare affiliation
• Bridgeport Hospital

  • General Acute Care Hospital
  • Bridgeport, CT
  • NPI 1992910152
  Care Compare affiliation

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

{
    "created_epoch": "1405900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429488000000",
    "number": "1245647486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "259 LIGHT ST",
            "city": "STRATFORD",
            "state": "CT",
            "postal_code": "066145233",
            "telephone_number": "203-583-5976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "64 BLACK ROCK AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066051200",
            "telephone_number": "203-579-5000",
            "fax_number": "203-579-5113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRUZ",
        "first_name": "LISSETTE",
        "middle_name": "I",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-21",
        "last_updated": "2015-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "003107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cenita Cruz, LCSW
• Chrystie Cruz
• Diana Cruz, LCSW
• Hugo Francisco Cruz, M.S.
• Keila Cruz
• Alexander Crystal, M.D
• CT ABA Services
• CT Braces Bridgeport Orthodontics PC
• CT Braces, LLC
• CT Watermark 3030, LLC

• Physician Assistant in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Physician Assistant in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2015; 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.