Individual provider Active NPI

Jaclyn Rose Neveu, PA-C

  • Medical Physician Assistant
  • Norwich, CT
National Provider Identifier
1669031563
Registry record updated Jun 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
4466 Issued in CT
Practice address
164 Otrobando Ave
Norwich, CT 06360-2116
Phone
(860) 886-0023
Fax
(860) 886-0024
NPI assigned
Jun 13, 2019
Last updated
Jun 13, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 4466 CT Primary

Addresses

Primary practice location

164 Otrobando Ave
Norwich, CT 06360-2116

Mailing address

164 Otrobando Ave
Norwich, CT 06360-2116
Phone (860) 886-0023

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20190903002766 CT Practitioner - Physician Assistant 9335478114 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Hartford Healthcare Medical Group Specialists PLLCGroup PAC ID 3173866241, 1,555 clinicians

Practice addresses (Care Compare)

111 Salem Tpke
Norwich, CT 06360-7403
Phone (860) 425-8700

1244 Storrs Rd
Road
Storrs, CT 06268-2200
Phone (860) 724-2579

37 Kennedy Dr
Suite a
Putnam, CT 06260-1960
Phone (860) 963-7519

863 N Main St Ext
Suite 101
Wallingford, CT 06492-2434
Phone (203) 269-3791

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.42 of 100Reported as group
Quality
83.36
Promoting interoperability
100
Improvement activities
40
Cost
75.9

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
4466CTMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Hartford Healthcare Medical Group Specialists, PLLC CurrentSince Sep 1, 2019 Accepting new patients
Hartford Healthcare Medical Group Specialists LLC CurrentSince Sep 1, 2019 Accepting new patients
Hartford Hospital Past Accepting new patients

Locations

111 Salem Tpke
Ste 8
Norwich, CT 06360
Phone (860) 886-0023

1244 Storrs Rd
Storrs Mansfield, CT 06268
Phone (860) 724-2579

1290 Silas Deane Hwy
Wethersfield, CT 06109
Phone (860) 972-6977

Interoperability endpoints

  • Direct secure messaging: jaclyn.neveu@xdr.hhchealthdirect.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1560384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560384000000",
    "number": "1669031563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "164 OTROBANDO AVE",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063602116",
            "telephone_number": "860-886-0023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "164 OTROBANDO AVE",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063602116",
            "telephone_number": "860-886-0023",
            "fax_number": "860-886-0024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEVEU",
        "first_name": "JACLYN",
        "middle_name": "ROSE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-13",
        "last_updated": "2019-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "4466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norwich, CT

Sources for this page

Verify at the official NPI Registry.