Rena Jacobs, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

002304 Issued in CT

Practice address

6 Main St
Durham, CT 06422-2126

Phone

(860) 349-1058

Fax

(860) 358-8652

NPI assigned

Sep 8, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Rena Bryan Former name

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

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rjacobs9867@middlesexhealthprd.direct-ci.com

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.

• MHS Primary Care Inc

  • Urgent Care Clinic/Center
  • Old Saybrook, CT
  • NPI 1093138935

  CT, Physician Assistant

  Medicare reassignment Care Compare group NPD
• MHS Primary Care, Inc

  • Family Medicine Physician
  • Middletown, CT
  • NPI 1336279058

  CT, Physician Assistant

  Medicare reassignment Care Compare group NPD (past)
• MHS Primary Care Inc

  • Internal Medicine Physician
  • Essex, CT
  • NPI 1750276655

  Physician Assistant

  Care Compare group NPD
• MHS Primary Care Inc

  • Family Nurse Practitioner
  • Middletown, CT
  • NPI 1366968182
  Care Compare group

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Middlesex Hospital

  • Home Health Agency
  • Middletown, CT
  • NPI 1194781328
  Care Compare affiliation Name & address match
• Middlesex Hospital

  • General Acute Care Hospital
  • Middletown, CT
  • NPI 1760454334

  Hospital

  Care Compare affiliation

Specialty

Physician Assistant

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

MHS Primary Care, Inc. 180 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Middlesex Health Care at Home and Hospice Program Home health agency, Middletown, CT, CCN 077086
• Middlesex Hospital Hospital, Middletown, CT, CCN 070020

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

{
    "created_epoch": "1252368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491955200000",
    "number": "1629301718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 CRESCENT ST",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064573654",
            "telephone_number": "860-358-4820",
            "fax_number": "860-358-8661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 MAIN ST",
            "city": "DURHAM",
            "state": "CT",
            "postal_code": "064222126",
            "telephone_number": "860-349-1058",
            "fax_number": "860-358-8652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACOBS",
        "first_name": "RENA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-08",
        "last_updated": "2017-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "002304",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008016826",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RENA",
            "last_name": "BRYAN",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Katrina Christine Griffin
• Growth Era Counseling & Wellness, LLC
• Nazmiye Esra Hatiboglu, MD
• Heather Ram, LMFT, LLC
• Jenna Olga Labbadia Holland, OTD, MS, OTR/L
• Robert A Jacobs
• Jason R Glazer DMD
• Shannon Jensen
• Caitlyn Keib
• Elizabeth Keyes Charles

• All providers in Durham, CT
• Physician Assistant in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2017; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.