Individual provider Active NPI

Stephanie Pellerin, PA-C

  • Physician Assistant
  • Concord, NH
National Provider Identifier
1417511817
Registry record updated Sep 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1650 Issued in NH
Practice address
250 Pleasant St
Concord, NH 03301-2598
Phone
(603) 225-2711
Fax
(603) 224-6527
NPI assigned
May 1, 2019
Last updated
Sep 28, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1650 NH Primary

Addresses

Primary practice location

250 Pleasant St
Concord, NH 03301-2598

Mailing address

250 Pleasant St
Concord, NH 03301-2598
Phone (603) 225-2711

Other practice location 1

716 Stevens Ave
Portland, ME 04103-2656
Phone (207) 283-0171

Other names 1

  • Stephanie Prygocki Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address spellerin@crhc.cernerdirect.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH
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
I20210908002518 NH Practitioner - Physician Assistant 5991101453 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Concord Hospital IncGroup PAC ID 6103721790, 572 clinicians

Practice addresses (Care Compare)

248 Pleasant St
Concord, NH 03301-2588

250 Pleasant St
Concord, NH 03301-2598

60 Commercial St
Concord, NH 03301-5096

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89 of 100Reported as apm
Quality
73.23
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1650NHMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Concord Hospital, Inc. CurrentSince Sep 27, 2021 Accepting new patients

Locations

248 Pleasant St
Ste 206
Concord, NH 03301
Phone (603) 230-7266

250 Pleasant St
Concord, NH 03301
Phone (603) 225-2711

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

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": "1556668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632787200000",
    "number": "1417511817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 PLEASANT ST",
            "city": "CONCORD",
            "state": "NH",
            "postal_code": "033012598",
            "telephone_number": "603-225-2711",
            "fax_number": "603-224-6527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 PLEASANT ST",
            "city": "CONCORD",
            "state": "NH",
            "postal_code": "033012598",
            "telephone_number": "603-225-2711",
            "fax_number": "603-224-6527"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "716 Stevens Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "ME",
            "postal_code": "041032656",
            "country_code": "US",
            "telephone_number": "207-283-0171",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PELLERIN",
        "first_name": "STEPHANIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-01",
        "last_updated": "2021-09-28",
        "certification_date": "2021-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NH",
            "license": "1650",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "spellerin@crhc.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Concord Hospital Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "250 Pleasant St",
            "city": "Concord",
            "state": "NH",
            "country_code": "US",
            "postal_code": "033012598",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "PRYGOCKI",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Concord, NH

Sources for this page

Verify at the official NPI Registry.