Susan St. Jacques, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

000445 Issued in CT

Practice address

1450 Chapel St
New Haven, CT 06511-4405

Phone

(203) 789-3011

NPI assigned

Jun 11, 2006

Last updated

Oct 11, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Saint Raphael Faculty Physicians

  • Internal Medicine Physician
  • New Haven, CT
  • NPI 1932138138
  NPD (past)

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

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192060800000",
    "number": "1467494872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 N MARK DR",
            "city": "OXFORD",
            "state": "CT",
            "postal_code": "064781565",
            "telephone_number": "203-888-7644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 CHAPEL ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065114405",
            "telephone_number": "203-789-3011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ST. JACQUES",
        "first_name": "SUSAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-11",
        "last_updated": "2007-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "000445",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Narat Srivali, M.D.
• Kenneth Ssebambulidde, MD, MSC.
• Shakirah Namuyomba Ssebyala, MD
• Michelle N St Pierre, LCSW
• St. Francis Home for Children Inc.
• Brad St. Martin, MD
• St. Raphael Dialysis Center Partnership (Saint Raphael Dialysis Center)
• St. Raphael Dialysis Center Partnership (Milford Dialysis Center)
• Tayisha Rebecca St. Vil, WHNP-BC
• Amanda Lee Staak, PHARM D

• Medical Physician Assistant in New Haven, CT
• Providers in New Haven, CT by specialty
• Medical Physician Assistant in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.