Carly Krisavage, PHYSICIAN ASSISTANT

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

4141 Issued in CT

Practice address

161 Boston Ave
Bridgeport, CT 06610-1662

Phone

(203) 333-4400

Fax

(203) 334-0729

NPI assigned

Jul 2, 2018

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 names 1

• Carly Krisavage Professional 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

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Community Health Center IncGroup PAC ID 0547169138, 149 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: carly.krisavage@chcict.eclinicaldirectplus.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.

• Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Middletown, CT
  • NPI 1952591851
  Medicare reassignment Care Compare group NPD
• QMG2,LLC

  • Urgent Care Clinic/Center
  • Fairfield, CT
  • NPI 1437546363
  Medicare reassignment
• QMG3, LLC

  • Urgent Care Clinic/Center
  • Shelton, CT
  • NPI 1053856039
  Medicare reassignment
• QMG4, LLC

  • Family Medicine Physician
  • Bridgeport, CT
  • NPI 1023471299
  Medicare reassignment
• Quentin Medical Group, LLC

  • Urgent Care Clinic/Center
  • Bridgeport, CT
  • NPI 1487087250
  Medicare reassignment
• Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Danbury, CT
  • NPI 1003332446
  NPD

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

{
    "created_epoch": "1530489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578873600000",
    "number": "1629564729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 STONEFIELD DR",
            "city": "PROSPECT",
            "state": "CT",
            "postal_code": "067121744",
            "telephone_number": "203-592-4376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 BOSTON AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066101662",
            "telephone_number": "203-333-4400",
            "fax_number": "203-334-0729"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1918 Black Rock Tpke",
            "address_purpose": "LOCATION",
            "city": "Fairfield",
            "state": "CT",
            "postal_code": "068253543",
            "country_code": "US",
            "telephone_number": "203-583-8400",
            "fax_number": "203-583-4777",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KRISAVAGE",
        "first_name": "CARLY",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-02",
        "last_updated": "2020-01-13",
        "certification_date": "2020-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "4141",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARLY",
            "last_name": "KRISAVAGE",
            "credential": "PA-C",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Sharon Kowalchik
• Michael Kraft
• Steven Krasnica, M.D.
• Nastajjia Krementz, MD
• Brian Krilivsky, R.D.
• Susan Krissel, CNM
• Shirley Kuan, MSN, AGNP
• Eric A Kuczynski, MD
• Brenda I Kulikowski, MSN; CERTIFIED NURSE
• Reuben Praharsh Kumar, M.B.B.S

• Physician Assistant in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Physician Assistant in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2020; 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.