Individual provider Active NPI

Wayne Perosky, PA

  • Surgical Physician Assistant
  • Hartford, CT
National Provider Identifier
1619979218
Registry record updated Jun 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
001210 Issued in CT
Practice address
114 Woodland St
Dept of Surgery
Hartford, CT 06105-1208
Phone
(860) 714-4694
Fax
(860) 714-8096
NPI assigned
Aug 12, 2005
Last updated
Jun 17, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 001210 CT Primary

Addresses

Primary practice location

114 Woodland St
Dept of Surgery
Hartford, CT 06105-1208

Mailing address

1000 Asylum Ave
Suite 2109a
Hartford, CT 06105-1770
Phone (860) 714-6581

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address wperosky9888@direct.stfranciscare.org Direct

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
I20070130000490 CT Practitioner - Physician Assistant 3476554684 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

114 Woodland St
Hartford, CT 06105-1208

31 Ensign Dr
Avon, CT 06001-3773
Phone (860) 525-4469

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
001210CTMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Trinity Health of New England Provider Network Organization Inc CurrentSince Jun 12, 2002 Accepting new patients
Orthopedic Surgical Partners, PC CurrentSince Nov 1, 2006 Accepting new patients
Orthopedic Surgical Partners, P.C. CurrentSince Nov 1, 2006 Accepting new patients
Saint Francis Care Medical Group, PC Past Accepting new patients

Locations

31 Ensign Dr
Avon, CT 06001
Phone (860) 409-9125

1000 Asylum Ave
Ste 2108
Hartford, CT 06105
Phone (860) 714-4097

114 Woodland St
Hartford, CT 06105
Phone (860) 714-4001

277 Middle Tpke W
Manchester, CT 06040
Phone (860) 432-4640

1111 Cromwell Ave
Ste 403
Rocky Hill, CT 06067

1111 Cromwell Ave
Ste 404
Rocky Hill, CT 06067
Phone 8605254469112

Interoperability endpoints

  • Direct secure messaging: wperosky2387898@direct.trinity-health.org

Organizations & group practices 5

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.

Hospital & facility affiliations 3

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": "1123804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623888000000",
    "number": "1619979218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 ASYLUM AVE",
            "address_2": "SUITE 2109A",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061051770",
            "telephone_number": "860-714-6581",
            "fax_number": "860-714-8311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 WOODLAND ST",
            "address_2": "DEPT OF SURGERY",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061051208",
            "telephone_number": "860-714-4694",
            "fax_number": "860-714-8096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEROSKY",
        "first_name": "WAYNE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-12",
        "last_updated": "2021-06-17",
        "certification_date": "2021-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CT",
            "license": "001210",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "wperosky9888@direct.stfranciscare.org",
            "affiliation": "N",
            "endpointDescription": "Trinity Health of New England Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "114 Woodland St",
            "city": "Hartford",
            "state": "CT",
            "country_code": "US",
            "postal_code": "061051208",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hartford, CT

Sources for this page

Verify at the official NPI Registry.