Mark A Gregorio, DNP, APRN, CNP, NP-C
Individual provider Active NPI Adult Health Nurse Practitioner · New Haven, CT
NPI 1598066698 · NPPES record last updated Oct 14, 2021
Key facts
- NPI
- 1598066698
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Health Nurse Practitioner 363LA2200X
- License
- 12.004539 (CT)
- Practice address
- 42 Concord St
New Haven, CT 06512-4005 - Phone
- (860) 823-0645
- NPI assigned
- Nov 6, 2010
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in CT, MA, NH
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120127000001 | CT | Practitioner - Nurse Practitioner | 6103093448 | Reassigns benefits to 1 organization |
| I20220818000724 | MA | Practitioner - Nurse Practitioner | 6103093448 | Reassigns benefits to 1 organization |
| I20230915001152 | NH | Practitioner - Nurse Practitioner | 6103093448 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4539 | CT | MD | Physician Assistant |
| 12.004539 | CT | MD | Adult Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Care Health Network LLC | Current |
Accepting new patients | |
| Advanced Pain and Regenerative Medical Solutions Corp | Current |
Accepting new patients | |
| Absolute Outcomes, LLC | Past | Accepting new patients | |
| Masonicare Behavioral Health, LLC | Past |
Accepting new patients | |
| Joint Pain Treatment Center, LLC | Past |
Accepting new patients |
Locations
9201 E Mountain View Rd
Ste 220
Scottsdale, AZ 85258
Phone (480) 862-1883
10 Progress Dr
Ste 2F
Shelton, CT 06484
Phone (203) 278-6394
1 Tara Blvd
Ste 200
Nashua, NH 03062
Phone (603) 242-2296
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 12.004539 | CT | Yes |
Addresses
Primary practice location
42 Concord St
New Haven, CT 06512-4005
Mailing address
42 Concord St
New Haven, CT 06512-4005
Phone (860) 823-0645
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4539 | Other | CT | APRN |
| 071501 | Other | CT | RN |
| RN2338443 | Other | MA | RN/APRN |
Other providers in New Haven, CT
- Michelle Paige Greenman
- Daniel Seth Greenstein
- Lee H Greenwood
- Max Greger-Moser
- Dominic John Gregorio
- Melissa Rendeiro Gregorio
- Debra Woodruff Gregory
- Francis Xavier Gregory
- Kathleen Grene
- Mildred Grenough
All providers in New Haven, CT · Adult Health Nurse Practitioner in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 14, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.