Individual provider Active NPI

Samantha Mirra

  • Physician Assistant
  • Norwich, CT
National Provider Identifier
1568201259
Registry record updated May 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
326 Washington St
Norwich, CT 06360-2740
Phone
(860) 889-8331
NPI assigned
May 22, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 22, 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 Primary

Addresses

Primary practice location

326 Washington St
Norwich, CT 06360-2740

Mailing address

326 Washington St
Norwich, CT 06360-2740
Phone (860) 889-8331

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
I20240916000609 CT Practitioner - Physician Assistant 8820539034 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The William W Backus HospitalGroup PAC ID 0749170645, 248 clinicians
Hartford HospitalGroup PAC ID 2567366016, 1,040 clinicians

Practice addresses (Care Compare)

326 Washington St
Norwich, CT 06360-2740
Phone (860) 889-8331

80 Seymour St
Hartford, CT 06102-8000
Phone (860) 545-7500

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
The Hospital of Central Connecticut at New Britain General and Bradley CurrentSince Sep 1, 2024 Accepting new patients
William W Backus Hospital CurrentSince Sep 1, 2024 Accepting new patients
Hartford Hospital CurrentSince Sep 1, 2024 Accepting new patients
The Hospital of Central Connecticut at New Britain General and Bradley CurrentSince Sep 1, 2024 Accepting new patients
Midstate Medical Center CurrentSince Sep 1, 2024 Accepting new patients

Locations

435 Lewis Ave
Meriden, CT 06451
Phone (203) 284-1340

100 Grand St
New Britain, CT 06052
Phone (860) 224-5011

326 Washington St
Norwich, CT 06360
Phone (860) 701-0140

1290 Silas Deane Hwy
Wethersfield, CT 06109
Phone (860) 972-6977

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.

Hospital & facility affiliations 5

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": "1716336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716336000000",
    "number": "1568201259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "326 WASHINGTON ST",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063602740",
            "telephone_number": "860-889-8331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "326 WASHINGTON ST",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063602740",
            "telephone_number": "860-889-8331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIRRA",
        "first_name": "SAMANTHA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-05-22",
        "last_updated": "2024-05-22",
        "certification_date": "2024-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norwich, CT

Sources for this page

Verify at the official NPI Registry.