Tracy G Civitillo, MHS, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

000974 Issued in CT

Practice address

500 Blue Hills Ave
Hartford, CT 06112-1500

Phone

(860) 714-4000

NPI assigned

Dec 27, 2006

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Interoperability endpoints

• Direct secure messaging: tracy.civitillo@145331296403460.direct.elationemr.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.

• Collins Medical Associates 2 PC

  • Internal Medicine Physician
  • Hartford, CT
  • NPI 1912928169
  NPD (past)

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

{
    "created_epoch": "1167177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1284681600000",
    "number": "1639235609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "71 HICKORY HILL RD",
            "city": "SIMSBURY",
            "state": "CT",
            "postal_code": "060702832",
            "telephone_number": "860-306-2087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 BLUE HILLS AVE",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061121500",
            "telephone_number": "860-714-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CIVITILLO",
        "first_name": "TRACY",
        "middle_name": "G",
        "name_prefix": "Ms.",
        "credential": "MHS, PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-27",
        "last_updated": "2010-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "000974",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "C03656",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mia Elizabeth Cirelli
• City of Hartford
• City of Hartford
• City of Hartford Hartford Public Schools
• Haydee Emperatriz Ciudad-Mercado, LCSW
• Bridget Claflin, APRN
• Jessica H Clancy
• Dana J Clapsaddle, DDS
• David R. Clark-Coller, APRN
• Allison J Clark

• Medical Physician Assistant in Hartford, CT
• Providers in Hartford, CT by specialty
• Medical Physician Assistant in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.