Active NPI
Jana Petelle, CRNA
- Certified Registered Nurse Anesthetist
- New London, CT
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 4030919
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3122430 | Medicaid | NH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ME, NH, RI, CT, KY
Enrollment records 5
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
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
| License | State | Type | Specialty |
|---|---|---|---|
| 11445 | CT | MD | Physical Medicine & Rehabilitation Physician |
| 204167 | CT | MD | Certified Registered Nurse Anesthetist |
| 4030919 | KY | MD | Certified Registered Nurse Anesthetist |
| RNA183052 | ME | MD | Certified Registered Nurse Anesthetist |
| 082357-23 | NH | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Yale University | Current | Accepting new patients | |
| Wentworth Douglass Physician Corporation | Current | Accepting new patients | |
| Yale University | Current | Accepting new patients | |
| Central Maine Medical Center | Current | Accepting new patients | |
| Mercy Hospital | Current | Accepting new patients | |
| University of Kentucky | Current | Accepting new patients | |
| Rumford Hospital | Current | Accepting new patients | |
| Bridgton Hospital | Current | Accepting new patients | |
| Mercy Hospital | Current | Accepting new patients | |
| Narragansett Bay Anesthesia, LLC | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
| Bridgton Hospital | Current | Accepting new patients | |
| Wentworth Douglass Physician Corporation | Current | Accepting new patients | |
| Central Maine Medical Center | Current | Accepting new patients | |
| Mercy Hospital | Current | Accepting new patients | |
| Northeast Medical Group, Inc. | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
| Rumford Hospital | Current | 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
- 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.
-
- Diagnostic Radiology Physician
- Lexington, KY
- NPI 1770771974
-
- Internal Medicine Physician
- Bridgeport, CT
- NPI 1043278351
Nurse Anesthetist, Certified Registered, RI
-
- Critical Access Hospital
- Bridgton, ME
- NPI 1154370153
-
- General Acute Care Hospital
- Lewiston, ME
- NPI 1689653487
-
- General Acute Care Hospital
- Portland, ME
- NPI 1629078712
-
- Anesthesiology Physician
- Warwick, RI
- NPI 1861445728
Nurse Anesthetist, Certified Registered
-
- Critical Access Hospital
- Rumford, ME
- NPI 1205991122
-
- Magnetic Resonance Imaging Radiologic Technologist
- Dover, NH
- NPI 1447352430
-
- Adult Mental Health Clinic/Center
- Hamden, CT
- NPI 1134391824
-
- Durable Medical Equipment & Medical Supplies
- Fairfield, CT
- NPI 1548066962
-
dba Bridgton Hospital Swing Bed
- Medicare Defined Swing Bed Hospital Unit
- Bridgton, ME
- NPI 1477691467
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Lexington, KY
- NPI 1518911338
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.