NPIMap

Individual provider Active NPI

Michael John Prestreau, PA-C

  • Surgical Physician Assistant
  • New Haven, CT
National Provider Identifier
1427650118
Registry record updated Feb 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
4960 Issued in CT
Practice address
1 Long Wharf Dr
New Haven, CT 06511-5991
Phone
(203) 688-8800
NPI assigned
Nov 9, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 4960 CT
Medical Physician Assistant 363AM0700X 4960 CT
Surgical Physician Assistant 363AS0400X 4960 CT Primary

Addresses

Primary practice location

1 Long Wharf Dr
New Haven, CT 06511-5991

Mailing address

1303 Leland Dr
Yorktown Heights, NY 10598-3621
Phone (914) 299-6248

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT, NY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210210001297 CT Practitioner - Physician Assistant 6204241904 Reassigns benefits to 2 organizations
I20230802001490 NY Practitioner - Physician Assistant 6204241904 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1 Blachley Rd
Stamford, CT 06902-0002
Phone (212) 774-7598

1133 Westchester Ave
White Plains, NY 10604-3516
Phone (646) 797-8973

535 E 70TH St
New York, NY 10021-4823
Phone (646) 797-8471

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ny Society for the Relief of Ruptured & Crippled Maintaining CurrentSince Jul 1, 2023 Accepting new patients
Yale University CurrentSince Feb 4, 2021 Accepting new patients
Yale University CurrentSince Feb 4, 2021 Accepting new patients

Locations

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

1 Long Wharf Dr
New Haven, CT 06511
Phone (203) 777-7500

1 Blachley Rd
Stamford, CT 06902
Phone (203) 705-0750

535 E 70th St
New York, NY 10021

Interoperability endpoints

  • FHIR API: https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/DSTU2
  • FHIR API: https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/R4/
  • Direct secure messaging: mprestreau24503@stamfordhealth.direct-ci.com

Organizations & group practices 3

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.

Hospital & facility affiliations 11

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": "1604880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612310400000",
    "number": "1427650118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1303 LELAND DR",
            "city": "YORKTOWN HEIGHTS",
            "state": "NY",
            "postal_code": "105983621",
            "telephone_number": "914-299-6248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 LONG WHARF DR",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065115991",
            "telephone_number": "203-688-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRESTREAU",
        "first_name": "MICHAEL",
        "middle_name": "JOHN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-11-09",
        "last_updated": "2021-02-03",
        "certification_date": "2021-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "4960",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "4960",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CT",
            "license": "4960",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Haven, CT

Sources for this page

Verify at the official NPI Registry.