Individual provider Active NPI

Jennifer L Sullivan, PA-C

  • Physician Assistant
  • Hamden, CT
National Provider Identifier
1437519949
Registry record updated Apr 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3526 Issued in CT
Practice address
1952 Whitney Ave
Hamden, CT 06517-1209
Phone
(203) 848-1803
Fax
(203) 848-1777
NPI assigned
Feb 25, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 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 3526 CT Primary

Addresses

Primary practice location

1952 Whitney Ave
Hamden, CT 06517-1209

Mailing address

1952 Whitney Ave
Hamden, CT 06517-1209
Phone (203) 848-1803

Other names 1

  • Jennifer L Crowther Former name

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
I20160621000217 CT Practitioner - Physician Assistant 9133410202 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hartford Healthcare Medical Group Specialists PLLCGroup PAC ID 3173866241, 1,555 clinicians

Practice addresses (Care Compare)

1244 Storrs Rd
Road
Storrs, CT 06268-2200
Phone (860) 724-2579

1290 Silas Deane Hwy
Wethersfield, CT 06109-4337
Phone (860) 827-7695

435 Lewis Ave
Meriden, CT 06451-2101

Hospital & facility affiliations

  • Midstate Medical Center Hospital, Meriden, CT, CCN 070017
  • Yale-New Haven Hospital Hospital, New Haven, CT, CCN 070022

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3526CTMDClinical Neuropsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Hartford Healthcare Medical Group Specialists LLC CurrentSince Dec 1, 2023 Accepting new patients
Hartford Healthcare Medical Group Specialists, PLLC CurrentSince Dec 1, 2023 Accepting new patients

Locations

455 Lewis Ave
Ste 210
Meriden, CT 06451
Phone (203) 238-1241

1244 Storrs Rd
Storrs Mansfield, CT 06268
Phone (860) 724-2579

Interoperability endpoints

  • Direct secure messaging: jcrowther@iss1780.srs-direct.com
  • Direct secure messaging: jsullivan511849@xdr.hhchealthdirect.org

Organizations & group practices 2

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 4

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": "1456358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617667200000",
    "number": "1437519949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1952 WHITNEY AVE",
            "city": "HAMDEN",
            "state": "CT",
            "postal_code": "065171209",
            "telephone_number": "203-848-1803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1952 WHITNEY AVE",
            "city": "HAMDEN",
            "state": "CT",
            "postal_code": "065171209",
            "telephone_number": "203-848-1803",
            "fax_number": "203-848-1777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "JENNIFER",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-02-25",
        "last_updated": "2021-04-06",
        "certification_date": "2021-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "3526",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "CROWTHER",
            "middle_name": "L",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Hamden, CT

Sources for this page

Verify at the official NPI Registry.