Individual provider Active NPI

Karlyn Marie Mott, PA-C

  • Physician Assistant
  • Hartford, CT
National Provider Identifier
1376853085
Registry record updated Sep 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
002500 Issued in CT
Practice address
80 Seymour Street
Hartford Hospital Medicine Dept
Hartford, CT 06102-5037
Phone
(860) 545-5176
NPI assigned
Oct 15, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 002500 CT Primary
Medical Physician Assistant 363AM0700X 2500 CT

Addresses

Primary practice location

80 Seymour Street
Hartford Hospital Medicine Dept
Hartford, CT 06102-5037

Mailing address

P. O. Box 415933
Hartford Hospital Professional Services
Boston, MA 02241-5933
Phone (860) 545-7602

Other identifiers 1

IdentifierTypeStateIssuer
003025224MedicaidCT

Other names 1

  • Karlyn Marie Miselis Former name

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110207000008 CT Practitioner - Physician Assistant 5496935645 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
002500CTMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Hartford Hospital CurrentSince Nov 29, 2010 Accepting new patients
Trinity Health of New England Provider Network Organization Inc CurrentSince Aug 20, 2012 Accepting new patients

Locations

114 Woodland St
Hartford, CT 06105
Phone (860) 714-4001

Organizations & group practices 4

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": "1287100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347235200000",
    "number": "1376853085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P. O. BOX 415933",
            "address_2": "HARTFORD HOSPITAL PROFESSIONAL SERVICES",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022415933",
            "telephone_number": "860-545-7602"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 SEYMOUR STREET",
            "address_2": "HARTFORD HOSPITAL MEDICINE DEPT",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061025037",
            "telephone_number": "860-545-5176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOTT",
        "first_name": "KARLYN",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-15",
        "last_updated": "2012-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "002500",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "2500",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003025224",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KARLYN",
            "last_name": "MISELIS",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Hartford, CT

Sources for this page

Verify at the official NPI Registry.