Individual provider Active NPI

Raya Pezzillo, PA-C

  • Physician Assistant
  • Newark, DE
National Provider Identifier
1497576318
Registry record updated Dec 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
C5-0012186 Issued in DE
Practice address
4755 Ogletown Stanton Rd FL 3
Newark, DE 19718-2200
Phone
(302) 623-0188
Fax
(302) 325-7056
NPI assigned
Oct 23, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2024

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 C5-0012186 DE Primary

Addresses

Primary practice location

4755 Ogletown Stanton Rd FL 3
Newark, DE 19718-2200

Mailing address

2242 Brookview PL
Elkins Park, PA 19027-2804

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE, MD2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20241223000575 DE Practitioner - Physician Assistant 9537696026 Reassigns benefits to 1 organization
I20250116001540 MD Practitioner - Physician Assistant 9537696026 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Union Hospital of Cecil CountyGroup PAC ID 6901719822, 281 clinicians
Christiana Care Health Services IncGroup PAC ID 9739097569, 1,480 clinicians

Practice addresses (Care Compare)

106 Bow St
Elkton, MD 21921-5544
Phone (410) 398-4000

4745 Ogletown Stanton Rd
Newark, DE 19713-2074
Phone (302) 623-7600

4755 Ogletown Stanton Rd
Newark, DE 19718-2200

501 W 14TH St
Wilmington, DE 19801-1013
Phone (302) 623-7600

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C5-0012186DEMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Christiana Care Health Services Inc CurrentSince Dec 17, 2024 Accepting new patients
Christiana Care Health Services Inc CurrentSince Dec 17, 2024 Accepting new patients
Union Hospital of Cecil County, Inc. CurrentSince Jan 6, 2025 Accepting new patients
Union Hospital of Cecil County CurrentSince Jan 6, 2025 Accepting new patients

Locations

4755 Ogletown Stanton Rd
Newark, DE 19718
Phone (302) 733-1700

4755 Ogletown Stanton Rd
Ste LE45
Newark, DE 19718
Phone (312) 733-1042

4755 Ogletown Stanton Rd
Fl 3
Newark, DE 19718
Phone (302) 733-3475

4745 Stanton Ogletwn Rd
Newark, DE 19713
Phone (302) 623-7600

1401 Foulk Rd
Ste 100B
Wilmington, DE 19803
Phone (302) 320-9440

4000 Nexus Dr
Ste E3
Wilmington, DE 19803

106 Bow St
Elkton, MD 21921
Phone (410) 298-2000

Organizations & group practices 4

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 2

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": "1729641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734393600000",
    "number": "1497576318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2242 BROOKVIEW PL",
            "city": "ELKINS PARK",
            "state": "PA",
            "postal_code": "190272804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4755 OGLETOWN STANTON RD FL 3",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197182200",
            "telephone_number": "302-623-0188",
            "fax_number": "302-325-7056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEZZILLO",
        "first_name": "RAYA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-23",
        "last_updated": "2024-12-17",
        "certification_date": "2024-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "DE",
            "license": "C5-0012186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, DE

Sources for this page

Verify at the official NPI Registry.