Individual provider Active NPI

Thomas Justin Kretsch, PA-C

  • Physician Assistant
  • Hartford, CT
National Provider Identifier
1285313346
Registry record updated Jan 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
6836 Issued in CT
Practice address
80 Seymour St
Hartford, CT 06102-8000
Phone
(860) 545-5000
NPI assigned
Jul 17, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2025

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 6836 CT Primary

Addresses

Primary practice location

80 Seymour St
Hartford, CT 06102-8000

Mailing address

80 Seymour St
Hartford, CT 06102-8000
Phone (860) 545-5000

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20241105001264 CT Practitioner - Physician Assistant 9638603236 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hartford Healthcare Medical Group Specialists PLLCGroup PAC ID 3173866241, 1,555 clinicians

Practice addresses (Care Compare)

1244 Storrs Rd
Road
Storrs, CT 06268-2200
Phone (860) 724-2579

280 S Main St
Cheshire, CT 06410-3112

80 Seymour St
Hartford, CT 06102-8000
Phone (860) 972-0549

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
6836CTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Hartford Healthcare Medical Group Specialists LLC CurrentSince Dec 15, 2024 Accepting new patients
Hartford Healthcare Medical Group Specialists, PLLC CurrentSince Dec 15, 2024 Accepting new patients
Trevecca Nazarene University PastSince Jul 1, 2023 Accepting new patients

Locations

280 S Main St
Ste 103
Cheshire, CT 06410

1244 Storrs Rd
Storrs Mansfield, CT 06268
Phone (860) 724-2579

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

Interoperability endpoints

  • Direct secure messaging: tkretsch570550@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 and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1689552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736553600000",
    "number": "1285313346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 SEYMOUR ST",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061028000",
            "telephone_number": "860-545-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 SEYMOUR ST",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061028000",
            "telephone_number": "860-545-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRETSCH",
        "first_name": "THOMAS",
        "middle_name": "JUSTIN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-07-17",
        "last_updated": "2025-01-11",
        "certification_date": "2025-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "6836",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hartford, CT

Sources for this page

Verify at the official NPI Registry.