NPIMap

Individual provider Active NPI

Jennifer Felicelli, PA-C

  • Physician Assistant
  • Mystic, CT
National Provider Identifier
1265656946
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
001410 Issued in CT
Practice address
23 Clara Dr
Mystic, CT 06355-1959
Phone
(860) 536-1666
Fax
(860) 536-9770
NPI assigned
Apr 12, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 001410 CT Primary

Addresses

Primary practice location

23 Clara Dr
Mystic, CT 06355-1959

Mailing address

5 N Broad St
Pawcatuck, CT 06379-1805
Phone (860) 599-4229

Other names 1

  • Jennifer Felicelli Deary Other name

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
I20040331000583 CT Practitioner - Physician Assistant 8729070701 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Hartford Healthcare Medical Group IncGroup PAC ID 1153573902, 257 clinicians

Practice addresses (Care Compare)

350 Liberty St
Pawcatuck, CT 06379-1354
Phone (860) 599-9961

55 Meriden Ave
Suite 1D
Southington, CT 06489-3239
Phone (860) 276-5144

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.48 of 100Reported as apm
Quality
83.4
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1410CTMDBehavioral Analyst
001410CTMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Hartford Healthcare Medical Group, Inc Physician Assistant CurrentSince Sep 1, 2017 Accepting new patients
Main Medical-Mystic, LLC PastSince Jul 12, 2002 Accepting new patients
Hartford Healthcare Medical Group, Inc Past Accepting new patients

Locations

23 Clara Dr
Mystic, CT 06355
Phone (860) 443-7907

23 Clara Dr
Ste 201
Mystic, CT 06355
Phone (860) 536-1666

111 Salem Tpke
Ste 8
Norwich, CT 06360
Phone (860) 886-0023

326 Washington St
Norwich, CT 06360
Phone (860) 701-0140

55 Meriden Ave
Ste 1D
Southington, CT 06489
Phone (860) 276-5144

1290 Silas Deane Hwy
Wethersfield, CT 06109
Phone (860) 972-6977

Interoperability endpoints

  • Direct secure messaging: jennifer.felicelli@xdr.hhchealthdirect.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1176336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1265656946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 N BROAD ST",
            "city": "PAWCATUCK",
            "state": "CT",
            "postal_code": "063791805",
            "telephone_number": "860-599-4229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 CLARA DR",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "063551959",
            "telephone_number": "860-536-1666",
            "fax_number": "860-536-9770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FELICELLI",
        "first_name": "JENNIFER",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "001410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "DEARY",
            "middle_name": "FELICELLI",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Mystic, CT

Sources for this page

Verify at the official NPI Registry.