Elise Mariam Sage, PNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

12.005079 Issued in CT

Practice address

869 Forbes St
East Hartford, CT 06118-1958

Phone

(860) 622-5343

NPI assigned

Sep 23, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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.

• Staywell Health Care, Inc.

  • Family Medicine Physician
  • Waterbury, CT
  • NPI 1154342335
  Medicare reassignment

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

{
    "created_epoch": "1316736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438214400000",
    "number": "1598048878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 PHOENIX AVE 201",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067021418",
            "telephone_number": "203-756-8021",
            "fax_number": "203-596-9038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "869 FORBES ST",
            "city": "EAST HARTFORD",
            "state": "CT",
            "postal_code": "061181958",
            "telephone_number": "860-622-5343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAGE",
        "first_name": "ELISE",
        "middle_name": "MARIAM",
        "credential": "PNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-23",
        "last_updated": "2015-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MA",
            "license": "2268080",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CT",
            "license": "12.005079",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CT",
            "license": "10.107616",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CT",
            "license": "005079",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lakesha S. Ruth
• Jahcasia Denyce Ryan
• Haleh Saadat, MD
• Maria Sacalosh, RDH
• Ketan Sadaria
• Payam Sajedi, M.D.
• Keri Lynn Saladin
• Eddie Salinas
• Olivia Marie Salvatore
• Lavinia Neluta Sambat, APRN

• Pediatric Nurse Practitioner in East Hartford, CT
• Providers in East Hartford, CT by specialty
• Pediatric Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.