Individual provider Active NPI

Jana Petelle, CRNA

  • Certified Registered Nurse Anesthetist
  • New London, CT
National Provider Identifier
1396194643
Registry record updated Jan 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
4030919 Issued in KY
Practice address
365 Montauk Ave
New London, CT 06320-4700
Phone
(860) 442-0711
NPI assigned
Jun 8, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 204167 CT
Certified Registered Nurse Anesthetist 367500000X RNA183052 ME
Certified Registered Nurse Anesthetist 367500000X 082357-23 NH
Certified Registered Nurse Anesthetist 367500000X 4030919 KY Primary

Addresses

Primary practice location

365 Montauk Ave
New London, CT 06320-4700

Mailing address

365 Montauk Ave
New London, CT 06320
Phone (603) 609-6819

Other practice location 1

800 Rose St
Lexington, KY 40536-4700
Phone (859) 323-5956

Other practice location 2

789 Central Ave
Dover, NH 03820-2526
Phone (603) 609-6819

Other practice location 3

716 Stevens Ave
Portland, ME 04103-2656
Phone (207) 221-4516

Other practice location 4

300 Main St
Lewiston, ME 04240-7027
Phone (207) 795-0111

Other identifiers 1

IdentifierTypeStateIssuer
3122430MedicaidNH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME, NH, RI, CT, KY5 enrollments

Enrollment records 5

Enrollment IDStateProvider typePAC IDDetails
I20190102002127 ME Practitioner - Certified Registered Nurse Anesthetist (Crna) 7315282845 Reassigns benefits to 4 organizations
I20200708000811 NH Practitioner - Certified Registered Nurse Anesthetist (Crna) 7315282845 Reassigns benefits to 1 organization
I20220209001658 RI Practitioner - Certified Registered Nurse Anesthetist (Crna) 7315282845 Reassigns benefits to 2 organizations
I20230914002796 CT Practitioner - Certified Registered Nurse Anesthetist (Crna) 7315282845 Reassigns benefits to 2 organizations
I20250218000679 KY Practitioner - Certified Registered Nurse Anesthetist (Crna) 7315282845 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Yale UniversityGroup PAC ID 9436061736, 2,632 clinicians
University of KentuckyGroup PAC ID 3072425289, 778 clinicians

Practice addresses (Care Compare)

800 Howard Ave
New Haven, CT 06519-1369
Phone (203) 785-2140

800 Rose St
Lexington, KY 40536-7001
Phone (859) 257-1000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11445CTMDPhysical Medicine & Rehabilitation Physician
204167CTMDCertified Registered Nurse Anesthetist
4030919KYMDCertified Registered Nurse Anesthetist
RNA183052MEMDCertified Registered Nurse Anesthetist
082357-23NHMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Yale University CurrentSince Nov 6, 2025 Accepting new patients
Wentworth Douglass Physician Corporation CurrentSince Jun 15, 2020 Accepting new patients
Yale University CurrentSince Nov 6, 2025 Accepting new patients
Central Maine Medical Center CurrentSince Nov 3, 2018 Accepting new patients
Mercy Hospital CurrentSince Jun 9, 2019 Accepting new patients
University of Kentucky CurrentSince Feb 5, 2025 Accepting new patients
Rumford Hospital CurrentSince Nov 3, 2018 Accepting new patients
Bridgton Hospital CurrentSince Nov 3, 2018 Accepting new patients
Mercy Hospital Current Accepting new patients
Narragansett Bay Anesthesia, LLC Nurse Anesthetist, Certified Registered CurrentSince Feb 14, 2022 Accepting new patients
Bridgton Hospital CurrentSince Nov 3, 2018 Accepting new patients
Wentworth Douglass Physician Corporation CurrentSince Jun 15, 2020 Accepting new patients
Central Maine Medical Center CurrentSince Nov 3, 2018 Accepting new patients
Mercy Hospital CurrentSince Jun 9, 2019 Accepting new patients
Northeast Medical Group, Inc. Nurse Anesthetist, Certified Registered CurrentSince Sep 18, 2023 Accepting new patients
Rumford Hospital CurrentSince Nov 3, 2018 Accepting new patients

Locations

52 Hazelnut Hill Rd
Groton, CT 06340
Phone (860) 446-8265

800 Howard Ave
New Haven, CT 06519
Phone (203) 785-2140

365 Montauk Ave
New London, CT 06320
Phone (860) 271-4364

95 Armory Rd
Stratford, CT 06614
Phone (203) 384-3388

800 Rose St
Lexington, KY 40536
Phone (859) 257-8562

10 Hospital Dr
Bridgton, ME 04009
Phone (207) 647-6000

300 Main St
Lewiston, ME 04240
Phone (207) 795-2400

364 Main St
Lewiston, ME 04240
Phone (207) 795-5646

420 Franklin St
Rumford, ME 04276
Phone (207) 364-4581

40 Park Rd
Westbrook, ME 04092
Phone (207) 857-8174

789 Central Ave
Dover, NH 03820
Phone (603) 740-2832

750 Central Ave
Ste Q
Dover, NH 03820
Phone (603) 742-6030

825 Chalkstone Ave
Providence, RI 02908
Phone (401) 456-2000

455 Toll Gate Rd
Warwick, RI 02886
Phone (401) 737-7000

25 Wells St
Westerly, RI 02891
Phone (401) 348-3325

45 East Ave
Westerly, RI 02891
Phone (401) 596-6000

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/4517c430-03bf-4e32-b324-1387cc4e73f3/

Organizations & group practices 17

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.

View all 17

Hospital & facility affiliations 1

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": "1465344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737676800000",
    "number": "1396194643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "365 MONTAUK AVE",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "06320",
            "telephone_number": "603-609-6819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "365 MONTAUK AVE",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063204700",
            "telephone_number": "860-442-0711"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 Rose St",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "KY",
            "postal_code": "405364700",
            "country_code": "US",
            "telephone_number": "859-323-5956",
            "fax_number": "859-323-1080",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "789 Central Ave",
            "address_purpose": "LOCATION",
            "city": "Dover",
            "state": "NH",
            "postal_code": "038202526",
            "country_code": "US",
            "telephone_number": "603-609-6819",
            "fax_number": "603-609-6821",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "716 Stevens Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "ME",
            "postal_code": "041032656",
            "country_code": "US",
            "telephone_number": "207-221-4516",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "300 Main St",
            "address_purpose": "LOCATION",
            "city": "Lewiston",
            "state": "ME",
            "postal_code": "042407027",
            "country_code": "US",
            "telephone_number": "207-795-0111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETELLE",
        "first_name": "JANA",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-08",
        "last_updated": "2025-01-24",
        "certification_date": "2025-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "CT",
            "license": "204167",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "ME",
            "license": "RNA183052",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NH",
            "license": "082357-23",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KY",
            "license": "4030919",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3122430",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New London, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.