NPIMap

Individual provider Active NPI

Jason Robert Fedak, PA-C

  • Medical Physician Assistant
  • Danbury, CT
National Provider Identifier
1679666572
Registry record updated Mar 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
001470 Issued in CT
Practice address
2 Main St
Danbury, CT 06810-8047
Phone
(203) 826-2140
Fax
(203) 826-2139
NPI assigned
Oct 2, 2006
Last updated
Mar 2, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2015

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 001470 CT Primary

Addresses

Primary practice location

2 Main St
Danbury, CT 06810-8047

Mailing address

2 Main St
Danbury, CT 06810-8047
Phone (860) 210-1850

Other identifiers 4

IdentifierTypeStateIssuer
147000OtherCONNECTICARE
290001470CT01OtherANTHEM BCBS
2V4615OtherHEALTHNET OF THE NORTHEAS
P3613396OtherOXFORD HEALTH PLANS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040701000768 CT Practitioner - Physician Assistant 8820075419 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
77.63 of 100Reported as group
Quality
62.23
Improvement activities
40
Cost
81.29

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Afc Physicians of Connecticut, PC CurrentSince Mar 14, 2014 Accepting new patients
Norwalk Hospital Association CurrentSince Mar 1, 2020 Accepting new patients
Norwalk Hospital Association CurrentSince Mar 1, 2020 Accepting new patients
Ctuc01 CurrentSince Mar 14, 2014 Accepting new patients
WRK Ventures, LLC Past Accepting new patients
Wilmington ASC LLC Past Accepting new patients
Carolina Sports Medicine &Orthopaedic Specialists PA Past Accepting new patients

Locations

2 Main St
Danbury, CT 06810
Phone (203) 826-2140

520 West Ave
Norwalk, CT 06850
Phone (203) 852-2417

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425254400000",
    "number": "1679666572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 MAIN ST",
            "city": "DANBURY",
            "state": "CT",
            "postal_code": "068108047",
            "telephone_number": "860-210-1850",
            "fax_number": "203-826-2139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 MAIN ST",
            "city": "DANBURY",
            "state": "CT",
            "postal_code": "068108047",
            "telephone_number": "203-826-2140",
            "fax_number": "203-826-2139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEDAK",
        "first_name": "JASON",
        "middle_name": "ROBERT",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2015-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "001470",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONNECTICARE",
            "identifier": "147000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "290001470CT01",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET OF THE NORTHEAS",
            "identifier": "2V4615",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD HEALTH PLANS",
            "identifier": "P3613396",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Danbury, CT

Sources for this page

Verify at the official NPI Registry.