Jeremy Booty, APRN
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Norwich, CT
NPI 1669877189 · NPPES record last updated Jan 20, 2015
Key facts
- NPI
- 1669877189
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 5947 (CT)
- Practice address
- 47 Town St
Norwich, CT 06360-2323 - Phone
- (860) 892-7042
- NPI assigned
- Oct 27, 2014
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- United Community and Family Services, Inc
Practice addresses (Care Compare)
47 Town St
Norwich, CT 06360-2323
Phone (860) 892-7042
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 |
|---|---|---|---|---|
| I20141120001538 | CT | Practitioner - Nurse Practitioner | 1254553571 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5947 | CT | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| United Community and Family Services, Inc. | Current |
Accepting new patients | |
| United Community and Family Services, Inc. | Current |
Accepting new patients |
Locations
212 Upton Rd
Ste C
Colchester, CT 06415
Phone (860) 537-7676
70 Main St
Jewett City, CT 06351
Phone (860) 376-7040
47 Town St
Norwich, CT 06360
800 Old Colchester Rd
Oakdale, CT 06370
Phone (860) 822-4775
Interoperability endpoints
- jbooty295598@direct.ochin.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 5947 | CT | Yes |
Addresses
Primary practice location
47 Town St
Norwich, CT 06360-2323
Mailing address
47 Town St
Norwich, CT 06360-2323
Phone (860) 892-7042
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 008056298 | Medicaid | CT |
Other providers in Norwich, CT
- Amber Jean Bonchuk
- Stephie Jovanie Bonheur
- Kathleen Bonin
- Kristin Bonner
- Kathryn H Bony
- Denise E Boras
- Krystyna E Borkowski
- Michelle Bosco
- Olivia Rae Bottini
- Johnda Ann Bouthillier
All providers in Norwich, 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 Jan 20, 2015. 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.