Charles Severo, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

003579 Issued in CT

Practice address

112 Quarry Road
Suite 400
Trumbull, CT 06611-4816

Phone

(203) 333-8800

Fax

(203) 333-6054

NPI assigned

Jun 16, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: csevero188853@direct.ynhh.org

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.

• Northeast Medical Group, Inc.

  • Internal Medicine Physician
  • Bridgeport, CT
  • NPI 1043278351
  Medicare reassignment NPD
• Mill Hill Medical Consultants Inc

  • Hospitalist Physician
  • Greenwich, CT
  • NPI 1841520293
  NPD

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

{
    "created_epoch": "1466035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467849600000",
    "number": "1639529068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 QUARRY ROAD",
            "address_2": "SUITE 400",
            "city": "TRUMBULL",
            "state": "CT",
            "postal_code": "066114816",
            "telephone_number": "203-333-8800",
            "fax_number": "203-333-6054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 QUARRY ROAD",
            "address_2": "SUITE 400",
            "city": "TRUMBULL",
            "state": "CT",
            "postal_code": "066114816",
            "telephone_number": "203-333-8800",
            "fax_number": "203-333-6054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEVERO",
        "first_name": "CHARLES",
        "name_prefix": "Mr.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-16",
        "last_updated": "2016-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "003579",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laurence Charles Segall, MS LCSW
• Sekerak M.D. & Tristine M.D., PC
• Jared G Selter, MD
• Garline Senatus
• Senior Care Management LLC
• Payal Shah, M.D.
• Joshua Shain, MSAOM
• Megan Shain, AU.D.
• Shareef Jandali Plastic Surgery LLC
• Patricia A Shatney, FNP-BC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.