Clarisse Melinda Fong San Juan, MD

Primary specialty

Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X

License

72590 Issued in CT

Practice address

20 York St
New Haven, CT 06510-3220

Phone

(203) 688-4242

NPI assigned

Jun 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 2

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Pain Management

Education

Loma Linda University School of Medicine, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Yale UniversityGroup PAC ID 9436061736, 2,632 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Yale-New Haven Hospital Hospital, New Haven, CT, CCN 070022
• Bridgeport Hospital Hospital, Bridgeport, CT, CCN 070010
• Gaylord Hospital Inc Long-term care hospital, Wallingford, CT, CCN 072003

Merit-based Incentive Payment System (MIPS)

Final score

87.36 of 100Reported as group

Quality

77.36

Promoting interoperability

100

Improvement activities

40

Cost

74.27

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: csanjuan571338@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.

• Yale University

  • Anesthesiology Physician
  • New Haven, CT
  • NPI 1205822236
  Medicare reassignment Care Compare group NPD
• Yale University

  • Adult Mental Health Clinic/Center
  • Hamden, CT
  • NPI 1134391824
  NPD
• Yale University

  • Durable Medical Equipment & Medical Supplies
  • Fairfield, CT
  • NPI 1548066962
  NPD
• Yale University

  • Health Service Clinic/Center
  • New Haven, CT
  • NPI 1093862740
  NPD (past)

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
• Gaylord Hospital, Inc.

  • Long Term Care Hospital
  • Wallingford, CT
  • NPI 1730137753

  Long-term care hospital

  Care Compare affiliation
• Yale New Haven Hospital

  • General Acute Care Hospital
  • New Haven, CT
  • NPI 1336139500
  Care Compare affiliation
• Yale New Haven Hospital

  • General Acute Care Hospital
  • New Haven, CT
  • NPI 1578778726
  Care Compare affiliation

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

{
    "created_epoch": "1498089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692316800000",
    "number": "1245750132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 YORK ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065103220",
            "telephone_number": "203-688-4242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 YORK ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065103220",
            "telephone_number": "203-688-4242"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Long Wharf Dr Fl 6",
            "address_purpose": "LOCATION",
            "city": "New Haven",
            "state": "CT",
            "postal_code": "065115991",
            "country_code": "US",
            "telephone_number": "203-688-8800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8 Devine St",
            "address_purpose": "LOCATION",
            "city": "North Haven",
            "state": "CT",
            "postal_code": "064732172",
            "country_code": "US",
            "telephone_number": "877-925-3637",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "659 George St",
            "address_purpose": "LOCATION",
            "city": "New Haven",
            "state": "CT",
            "postal_code": "065115324",
            "country_code": "US",
            "telephone_number": "203-680-7542",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "111 Goose Ln",
            "address_purpose": "LOCATION",
            "city": "Guilford",
            "state": "CT",
            "postal_code": "064375101",
            "country_code": "US",
            "telephone_number": "203-204-0400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SAN JUAN",
        "first_name": "CLARISSE MELINDA",
        "middle_name": "FONG",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-06-22",
        "last_updated": "2023-08-18",
        "certification_date": "2023-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CT",
            "license": "72590",
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "CT",
            "license": "72590",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shayla Samuel
• Elizabeth Anne Samuels, M.D., MPH
• Keri-Ann Samuels
• Stephanie Lynn Samuels, M.D.
• Sam Samuelson
• Hamaiyal Sana, MD, MPH
• Gerard Sanacora, M.D., PH.D.
• Sirisha Sanamandra, M.D.
• Marissa Meegan Sanca, APRN
• Mayra Janet Sanchez de la Cruz, MD

• Pain Medicine (Physical Medicine & Rehabilitation) Physician in New Haven, CT
• Providers in New Haven, CT by specialty
• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 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.