NPIMap

Individual provider Active NPI

Stacy Brittany Beaupre, PA

  • Physician Assistant
  • Enfield, CT
National Provider Identifier
1528388709
Registry record updated Oct 17, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
4083 Issued in CT
Practice address
55 Hazard Ave
Enfield, CT 06082-3813
Phone
(860) 745-9911
NPI assigned
Jun 10, 2010
Last updated
Oct 17, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2022

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 4083 CT Primary

Addresses

Primary practice location

55 Hazard Ave
Enfield, CT 06082-3813

Mailing address

55 Hazard Ave Unit 1
Enfield, CT 06082-3813
Phone (860) 745-9911

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180531002484 CT Practitioner - Physician Assistant 2466636949 Reassigns benefits to 10 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
May accept Medicare assignment
Group practices
Midstate Radiology Associates LLCGroup PAC ID 4880593565, 89 clinicians
Antero Urgent Care LLCGroup PAC ID 2062803422, 7 clinicians

Practice addresses (Care Compare)

100 Grand St
New Britain, CT 06052-2016
Phone (203) 949-2700

326 Washington St
Norwich, CT 06360-2740
Phone (203) 949-2700

39 Nott Hwy
Unit 7
Ashford, CT 06278-1341
Phone (860) 477-1267

435 Lewis Ave
Meriden, CT 06451-2101
Phone (203) 949-2700

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Antero, Inc CurrentSince Oct 3, 2025 Accepting new patients
The Charlotte Hungerford Hospital CurrentSince Apr 27, 2020 Accepting new patients
Antero Urgent Care LLC CurrentSince Oct 3, 2025 Accepting new patients
Nems PLLC Past Accepting new patients
Via Christi Medical Clinic, Inc. Past Accepting new patients
Valley Emergency Physicians New Mexico PC Past Accepting new patients

Locations

39 Nott Hwy
Unit 7
Ashford, CT 06278
Phone (860) 477-1267

540 Litchfield St
Torrington, CT 06790
Phone (860) 496-6361

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 10

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": "1276128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665964800000",
    "number": "1528388709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 HAZARD AVE UNIT 1",
            "city": "ENFIELD",
            "state": "CT",
            "postal_code": "060823813",
            "telephone_number": "860-745-9911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 HAZARD AVE",
            "city": "ENFIELD",
            "state": "CT",
            "postal_code": "060823813",
            "telephone_number": "860-745-9911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEAUPRE",
        "first_name": "STACY",
        "middle_name": "BRITTANY",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-10",
        "last_updated": "2022-10-17",
        "certification_date": "2022-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "4083",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Enfield, CT

Sources for this page

Verify at the official NPI Registry.