Individual provider Active NPI

Elizabeth Jentzen, RN

  • Midwife
  • Stamford, CT
National Provider Identifier
1346859923
Registry record updated Sep 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
MidwifeTaxonomy code 176B00000X
License
501 Issued in CT
Practice address
1275 Summer St
Stamford, CT 06905-5359
Phone
(203) 978-5775
NPI assigned
Jul 29, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Midwife 176B00000X 501 CT Primary
Registered Nurse 163W00000X 143279 CT

Addresses

Primary practice location

1275 Summer St
Stamford, CT 06905-5359

Mailing address

3231 Town Walk Dr
Hamden, CT 06518-3706
Phone (203) 427-1624

Other practice location 1

3231 Town Walk Dr
Hamden, CT 06518-3706
Phone (203) 427-1624

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260505003786 CT Practitioner - Certified Nurse Midwife (CNM) 3678041977 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Nurse Midwife (CNM)
Education
Other, 2021
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

50 Division St
New Haven, CT 06511-1936

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
143279CTMDRegistered Nurse
501CTMDHearing Instrument Specialist

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1595980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631577600000",
    "number": "1346859923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3231 TOWN WALK DR",
            "city": "HAMDEN",
            "state": "CT",
            "postal_code": "065183706",
            "telephone_number": "203-427-1624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1275 SUMMER ST",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069055359",
            "telephone_number": "203-978-5775"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3231 Town Walk Dr",
            "address_purpose": "LOCATION",
            "city": "Hamden",
            "state": "CT",
            "postal_code": "065183706",
            "country_code": "US",
            "telephone_number": "203-427-1624",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JENTZEN",
        "first_name": "ELIZABETH",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-29",
        "last_updated": "2021-09-14",
        "certification_date": "2021-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "176B00000X",
            "taxonomy_group": "",
            "desc": "Midwife",
            "state": "CT",
            "license": "501",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CT",
            "license": "143279",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stamford, CT

Sources for this page

Verify at the official NPI Registry.