NPIMap

Individual provider Active NPI

Samuel W. Gaston, PA

  • Surgical Physician Assistant
  • Farmington, CT
National Provider Identifier
1316003908
Registry record updated Sep 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
000828 Issued in CT
Practice address
263 Farmington Ave
Farmington, CT 06030-0001
Phone
(860) 679-2290
NPI assigned
Dec 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 000828 CT Primary

Addresses

Primary practice location

263 Farmington Ave
Farmington, CT 06030-0001

Mailing address

263 Farmington Ave
Provider Enrollment
Farmington, CT 06030-2212
Phone (860) 679-7503

Other identifiers 1

IdentifierTypeStateIssuer
1316003908MedicaidCT

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sgaston10755@direct.med.uchc.edu

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
I20080714000235 CT Practitioner - Physician Assistant 3375616063 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
JS Weill Medical College, Cornell University, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Connecticut Health CenterGroup PAC ID 3678472016, 624 clinicians

Practice addresses (Care Compare)

263 Farmington Ave
Farmington, CT 06030-0001
Phone (860) 679-3692

263 Farmington Ave
Farmington, CT 06030-8082

Hospital & facility affiliations

  • John Dempsey Hospital of the University of Connect Hospital, Farmington, CT, CCN 070036

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
000828CTMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
State of Connecticut CurrentSince Apr 1, 2020 Accepting new patients
University of Connecticut Health Center CurrentSince May 1, 2008 Accepting new patients
State of Connecticut CurrentSince Apr 1, 2020 Accepting new patients
University of Connecticut Health Center CurrentSince May 1, 2008 Accepting new patients
University of Connecticut Health Center Past Accepting new patients

Locations

263 Farmington Ave
Farmington, CT 06030
Phone (860) 679-4477

Interoperability endpoints

  • Direct secure messaging: sgaston10755@direct.med.uchc.edu

Organizations & group practices 6

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": "1167264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663632000000",
    "number": "1316003908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "263 FARMINGTON AVE",
            "address_2": "PROVIDER ENROLLMENT",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060302212",
            "telephone_number": "860-679-7503",
            "fax_number": "860-679-1610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "263 FARMINGTON AVE",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060300001",
            "telephone_number": "860-679-2290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GASTON",
        "first_name": "SAMUEL",
        "middle_name": "W.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-28",
        "last_updated": "2022-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CT",
            "license": "000828",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1316003908",
            "state": "CT"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sgaston10755@direct.med.uchc.edu",
            "affiliation": "N",
            "address_1": "Uconn Medical Group",
            "address_2": "263 Farmington Avenue",
            "city": "Farmington",
            "state": "CT",
            "country_code": "US",
            "postal_code": "060300001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Farmington, CT

Sources for this page

Verify at the official NPI Registry.