Ava Rose Boornazian, APRN
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Waterbury, CT
NPI 1639105166 · NPPES record last updated Oct 19, 2021
Key facts
- NPI
- 1639105166
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 002444 (CT)
- Practice address
- 56 Franklin St
Waterbury, CT 06706-1221 - Phone
- (203) 709-6000
- Fax
- (203) 709-8849
- NPI assigned
- Jun 25, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 1996
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Trinity Health of New England Provider Network Organization Inc
Practice addresses (Care Compare)
56 Franklin St
Waterbury, CT 06706-1253
Phone (203) 709-6000
Hospital & facility affiliations
- Saint Mary'S Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- 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 |
|---|---|---|---|---|
| I20100122000394 | CT | Practitioner - Nurse Practitioner | 2466594817 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Specialist, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002444 | CT | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Trinity Health of New England Provider Network Organization Inc | Current |
Accepting new patients | |
| Trinity Health of New England Provider Network Organization Inc | Current |
Accepting new patients | |
| State of Connecticut | Past | Accepting new patients | |
| State of Connecticut | Past |
Accepting new patients |
Locations
114 Woodland St
Hartford, CT 06105
Phone (860) 714-4001
Interoperability endpoints
- aboornazian2388761@direct.trinity-health.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 002444 | CT | Yes |
Addresses
Primary practice location
56 Franklin St
Waterbury, CT 06706-1221
Mailing address
56 Franklin St
3Rd Floor
Waterbury, CT 06706-1221
Phone (203) 709-8873
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004213253 | Medicaid | CT |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | aboornazian225398@direct.stfranciscare.org | Direct |
Other providers in Waterbury, CT
- Mark Bonaventura Jr.
- Nicholas Bonomo
- Imani Booker-Youngs
- Wanda C Booker
- Louvonia R Boone
- Hellen Borja
- Henry J Borkowski
- Nicole Borusiewicz
- Carolina Ioana Borz Baba
- Angela Lynn Bosjolie
All providers in Waterbury, CT · Psychiatric/Mental 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 19, 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.