Andrea Jacobs-Stannard, P.A.
Individual provider Active NPI Medical Physician Assistant · New Haven, CT
NPI 1295852440 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1295852440
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 001566 (CT)
- Practice address
- 20 York St # CB-2041
Ynh Medical Services PC
New Haven, CT 06504-8900 - Phone
- (203) 688-4748
- Fax
- (203) 688-4740
- NPI assigned
- Mar 23, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Northeast Medical Group Inc
Adult and Pediatric Dermatology Specialists, P.C.
Practice addresses (Care Compare)
1450 Chapel St
New Haven, CT 06511-4405
Phone (203) 789-3633
160 Hawley LN
Trumbull, CT 06611-5379
Phone (203) 377-0639
20 York St
New Haven, CT 06510-3220
95 Armory Rd
Stratford, CT 06614-1702
Phone (203) 384-3388
Hospital & facility affiliations
- Yale-New Haven Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 100 of 100
- Quality
- 86.54
- Promoting interoperability
- 99.98
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050120000844 | CT | Practitioner - Physician Assistant | 1355390915 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001566 | CT | MD | Marriage & Family Therapist |
| 1566 | CT | MD | Athletic Trainer |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Adult & Pediatric Dermatology Specialists, P.C. | Current |
Accepting new patients | |
| Yale University | Current |
Accepting new patients | |
| Yale University | Current |
Accepting new patients | |
| Northeast Medical Group, Inc. | Current |
Accepting new patients | |
| Mill Hill Medical Consultants Inc | Current |
Accepting new patients |
Locations
130 Division St
Derby, CT 06418
Phone (203) 732-1330
299 Seymour Ave
Derby, CT 06418
Phone (203) 377-0639
55 Lock St
Ofc 4TH
New Haven, CT 06511
55 Lock St
New Haven, CT 06511
Phone (203) 432-0076
20 York St
North Haven, CT 06510
Phone (203) 688-2433
20 York St
#2041
North Haven, CT 06510
Phone (203) 688-1734
95 Armory Rd
Stratford, CT 06614
Phone (203) 384-3388
160 Hawley Ln
Ste 104
Trumbull, CT 06611
Phone (203) 377-0639
160 Hawley Ln
Trumbull, CT 06611
Phone (203) 375-3456
Interoperability endpoints
- astannard4696@direct.ynhh.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 001566 | CT | Yes |
Addresses
Primary practice location
20 York St # CB-2041
Ynh Medical Services PC
New Haven, CT 06504-8900
Mailing address
20 York St
CB-2041
New Haven, CT 06504-8900
Phone (203) 688-4748
Other providers in New Haven, CT
- Krystal Jackson
- Rebekah Jackson
- Tabisha Jackson
- Tamiko V Jackson
- Van Rieves Jackson IV
- Harris C Jacobs
- Lauren Ashley Jacobs
- Mark Jacobs
- Menachem Jacobs
- Richard A Jacobs
All providers in New Haven, CT · Medical Physician Assistant in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.