Jayme Leigh Mickelson, D.O.

Key facts

NPI

1497989123

Entity type

Individual (NPI type 1)

Primary specialty

Internal Medicine Physician 207R00000X

License

053732 (CT)

Practice address

22 Pine St
Bristol, CT 06010-6948

Phone

(860) 584-8291

Fax

(860) 581-8354

NPI assigned

May 9, 2009

Sex

Female

Sole proprietor

No

Organizations & group practices 8

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.

• Hartford Healthcare Medical Group, Inc Surgery Physician · Wethersfield, CT · NPI 1043561301
  Medicare reassignment Care Compare group NPD CT · INTERNAL MEDICINE
• Midstate Medical Center General Acute Care Hospital · Meriden, CT · NPI 1154425288
  Medicare reassignment NPD CT
• The Charlotte Hungerford Hospital General Acute Care Hospital · Torrington, CT · NPI 1629075734
  Medicare reassignment NPD CT
• The Hospital of Central Connecticut at New Britain General and Bradley Hospitalist Physician · New Britain, CT · NPI 1063461481
  Medicare reassignment NPD CT · INTERNAL MEDICINE
• Midstate Medical Center Psychiatric Hospital Unit · Meriden, CT · NPI 1316022718
  NPD
• Midstate Medical Center General Acute Care Hospital · Meriden, CT · NPI 1427007848
  NPD
• The Charlotte Hungerford Hospital Psychiatric Hospital Unit · Torrington, CT · NPI 1639255870
  NPD
• The Hospital of Central Connecticut at New Britain General and Bradley Psychiatric Hospital Unit · New Britain, CT · NPI 1992867006
  NPD

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Hartford Healthcare at Home, Inc Home Health Agency · Wethersfield, CT · NPI 1073529566
  Care Compare affiliation Home health agency
• New Britain General Hospital General Acute Care Hospital · New Britain, CT · NPI 1548225360
  Care Compare affiliation Hospital
• The Hospital of Central Connecticut at New Britain General and Bradley General Acute Care Hospital · New Britain, CT · NPI 1053477075
  Care Compare affiliation Hospital

Medicare Care Compare profile

Specialty

Internal Medicine

Education

University of New England, College of Osteo Medicine, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Hartford Healthcare Medical Group Inc (257 clinicians)

Practice addresses (Care Compare)

Hospital & facility affiliations

• Hartford Healthcare at Home Home health agency · East Hartford, CT · CCN 077041
• The Hospital of Central Connecticut Hospital · New Britain, CT · CCN 070035

Merit-based Incentive Payment System (MIPS)

Final score

94.48 of 100 (apm)

Quality

83.4

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare participation

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jayme.mickelson@xdr.hhchealthdirect.org

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 24, 2020.

{
    "created_epoch": "1241827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585008000000",
    "number": "1497989123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 PINE ST",
            "city": "BRISTOL",
            "state": "CT",
            "postal_code": "060106948",
            "telephone_number": "860-584-8291",
            "fax_number": "860-581-8354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 PINE ST",
            "city": "BRISTOL",
            "state": "CT",
            "postal_code": "060106948",
            "telephone_number": "860-584-8291",
            "fax_number": "860-581-8354"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "129 Patricia M Genova Dr",
            "address_purpose": "LOCATION",
            "city": "Newington",
            "state": "CT",
            "postal_code": "061111543",
            "country_code": "US",
            "telephone_number": "860-972-8100",
            "fax_number": "860-545-1455",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MICKELSON",
        "first_name": "JAYME",
        "middle_name": "LEIGH",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-09",
        "last_updated": "2020-03-24",
        "certification_date": "2020-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MN",
            "license": "55713",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CT",
            "license": "053732",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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