Individual provider Active NPI

William John Perillo, D.O

  • Anesthesiology Physician
  • Staten Island, NY
National Provider Identifier
1306292693
Registry record updated May 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
65146 Issued in CT
Practice address
355 Bard Ave
Department of Medicine Villa BLDG 1St Floor
Staten Island, NY 10310-1664
Phone
(718) 818-2419
NPI assigned
May 5, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Anesthesiology Physician 207L00000X 65146 CT Primary

Addresses

Primary practice location

355 Bard Ave
Department of Medicine Villa BLDG 1St Floor
Staten Island, NY 10310-1664

Mailing address

355 Bard Ave
Department of Medicine Villa BLDG 1St Floor
Staten Island, NY 10310-1664
Phone (718) 818-2419

Other practice location 1

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200521002546 CT Practitioner - Anesthesiology 9638436603 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
New York College of Osteo Medicine of New York Institute of Technology, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Integrated Anesthesia Associates LLCGroup PAC ID 1759281165, 402 clinicians

Practice addresses (Care Compare)

2800 Main St
Bridgeport, CT 06606-4201
Phone (877) 442-2455

435 Lewis Ave
Meriden, CT 06451-2101
Phone (860) 282-0833

80 Semour St
Hartford, CT 06106-3315
Phone (860) 972-2117

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
65146CTMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Integrated Anesthesia Associates LLC Anesthesiology CurrentSince May 1, 2020 Accepting new patients

Locations

80 Seymour St
Hartford, CT 06106
Phone (860) 545-2249

2 Trap Falls Rd
Ste 414
Shelton, CT 06484
Phone (860) 282-4128

2 Corporate Dr
Ste 955
Shelton, CT 06484
Phone (203) 929-7375

Organizations & group practices 1

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 3

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": "1462406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589414400000",
    "number": "1306292693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "355 BARD AVE",
            "address_2": "DEPARTMENT OF MEDICINE VILLA BLDG 1ST FLOOR",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103101664",
            "telephone_number": "718-818-2419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 BARD AVE",
            "address_2": "DEPARTMENT OF MEDICINE VILLA BLDG 1ST FLOOR",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103101664",
            "telephone_number": "718-818-2419"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "80 Seymour St",
            "address_purpose": "LOCATION",
            "city": "Hartford",
            "state": "CT",
            "postal_code": "061028000",
            "country_code": "US",
            "telephone_number": "860-545-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PERILLO",
        "first_name": "WILLIAM",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-05",
        "last_updated": "2020-05-14",
        "certification_date": "2020-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CT",
            "license": "65146",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.