Individual provider Active NPI

Nicole Christine Tino, PA-C

  • Physician Assistant
  • Manchester, CT
National Provider Identifier
1447533534
Registry record updated Nov 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
002647 Issued in CT
Practice address
353 Main St
Manchester, CT 06040-4145
Phone
(860) 649-3477
NPI assigned
Sep 24, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2014

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 002647 CT Primary

Addresses

Primary practice location

353 Main St
Manchester, CT 06040-4145

Mailing address

703 High Rd
Berlin, CT 06037-1936
Phone (860) 485-3565

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
I20111122000146 CT Practitioner - Physician Assistant 7416121835 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Middlesex Gastroenterology Associates, LLCGroup PAC ID 5597657627, 13 clinicians

Practice addresses (Care Compare)

410 Saybrook Rd
Suite 201
Middletown, CT 06457-4777
Phone (860) 347-4620

Hospital & facility affiliations

  • Middlesex Hospital Hospital, Middletown, CT, CCN 070020

Merit-based Incentive Payment System (MIPS)

Final score
90.77 of 100Reported as group
Quality
90.77
Improvement activities
40
Cost
74.77

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
002647CTMDMental Health Counselor
2647CTMDClinical Neuropsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Eastern Connecticut Medical Professionals Foundation Inc Current Accepting new patients
Integrated Anesthesia Associates LLC Physician Assistant Past Accepting new patients

Locations

353 Main St
Manchester, CT 06040
Phone (860) 649-3477

6 Fieldstone Cmns
Ste D
Tolland, CT 06084
Phone (860) 871-6710

Interoperability endpoints

  • Direct secure messaging: ntino@mgact.gwaydirect.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 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": "1316822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415145600000",
    "number": "1447533534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "703 HIGH RD",
            "city": "BERLIN",
            "state": "CT",
            "postal_code": "060371936",
            "telephone_number": "860-485-3565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "353 MAIN ST",
            "city": "MANCHESTER",
            "state": "CT",
            "postal_code": "060404145",
            "telephone_number": "860-649-3477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TINO",
        "first_name": "NICOLE",
        "middle_name": "CHRISTINE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-24",
        "last_updated": "2014-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "002647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, CT

Sources for this page

Verify at the official NPI Registry.