Active NPI
Randy L Panke, NCCPA
- Physician Assistant
- Groton, CT
National Provider Identifier
1285699488
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 159 Trout Ave
Navsubase Nlon
Groton, CT 06349-5159 - Phone
- (860) 694-6464
- NPI assigned
- Apr 19, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
159 Trout Ave
Navsubase Nlon
Groton, CT 06349-5159
Mailing address
PSC 1005 Box 11185
Fpo, AA 34009-0112
Phone (757) 458-2998
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003017 | CT | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145404800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721779200000",
"number": "1285699488",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "MIL",
"address_1": "PSC 1005 BOX 11185",
"city": "FPO",
"state": "AA",
"postal_code": "340090112",
"telephone_number": "757-458-2998"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "159 TROUT AVE",
"address_2": "NAVSUBASE NLON",
"city": "GROTON",
"state": "CT",
"postal_code": "063495159",
"telephone_number": "860-694-6464"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PANKE",
"first_name": "RANDY",
"middle_name": "L",
"name_prefix": "Mr.",
"credential": "NCCPA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-19",
"last_updated": "2024-07-24",
"certification_date": "2024-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Groton, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.