Active NPI
Ian Gragnolati, PA-C
- Physician Assistant
- West Hartford, CT
National Provider Identifier
1689368466
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 6212
- Practice address
- 836 Farmington Ave Ste 207
West Hartford, CT 06119-1551 - Phone
- (860) 232-9911
- NPI assigned
- Jun 6, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 6212 | CT | Primary |
Addresses
Primary practice location
836 Farmington Ave Ste 207
West Hartford, CT 06119-1551
Mailing address
25 Roberts St
Windsor Locks, CT 06096-2113
Phone (860) 970-4913
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
836 Farmington Ave
Suite 207
West Hartford, CT 06119-1544
Phone (860) 232-9911
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6212 | CT | MD | Physician Assistant |
Interoperability endpoints
- igragnolati326707@xdr.hhchealthdirect.org
Organizations & group practices 1
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.
-
- Clinical & Laboratory Immunology (Allergy & Immunology) Physician
- West Hartford, CT
- NPI 1386604270
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1686009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692662400000",
"number": "1689368466",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25 ROBERTS ST",
"city": "WINDSOR LOCKS",
"state": "CT",
"postal_code": "060962113",
"telephone_number": "860-970-4913"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "836 FARMINGTON AVE STE 207",
"city": "WEST HARTFORD",
"state": "CT",
"postal_code": "061191551",
"telephone_number": "860-232-9911"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAGNOLATI",
"first_name": "IAN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-06-06",
"last_updated": "2023-08-22",
"certification_date": "2023-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CT",
"license": "6212",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Hartford, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2023; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.