Individual provider Active NPI

Michael E Tortorello I, PA-C

  • Medical Physician Assistant
  • Farmington, CT
National Provider Identifier
1417126087
Registry record updated Jun 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
000653 Issued in CT
Practice address
21 South Rd
Dermatology
Farmington, CT 06032-2410
Phone
(860) 679-4600
Fax
(860) 679-1248
NPI assigned
Feb 27, 2008
Last updated
Jun 15, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 000653 CT Primary
Surgical Physician Assistant 363AS0400X 000653 CT

Addresses

Primary practice location

21 South Rd
Dermatology
Farmington, CT 06032-2410

Mailing address

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

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
I20080415000118 CT Practitioner - Physician Assistant 6800973991 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
000653CTMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
University of Connecticut Health Center CurrentSince Sep 2, 2009 Accepting new patients
Enfield Dermatology LLC PastSince Apr 5, 2000 Accepting new patients
University of Connecticut Health Center Past Accepting new patients

Locations

21 South Rd
Farmington, CT 06032
Phone (860) 679-4600

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1204070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339718400000",
    "number": "1417126087",
    "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": "21 SOUTH RD",
            "address_2": "DERMATOLOGY",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060322410",
            "telephone_number": "860-679-4600",
            "fax_number": "860-679-1248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TORTORELLO",
        "first_name": "MICHAEL",
        "middle_name": "E",
        "name_prefix": "Mr.",
        "name_suffix": "I",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-02-27",
        "last_updated": "2012-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "000653",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CT",
            "license": "000653",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, CT

Sources for this page

Verify at the official NPI Registry.