Doreen A. Rackliffe, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

000825 Issued in CT

Practice address

255 N Main St
Suite 100
Bristol, CT 06010-4972

Phone

(860) 582-3942

Fax

(860) 584-6529

NPI assigned

Jan 4, 2006

Sex

Female

Sole proprietor

No

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.

• Trinity Health of New England Provider Network Organization Inc

  • Internal Medicine Physician
  • Hartford, CT
  • NPI 1003882812

  CT

  Medicare reassignment Care Compare group
• Trinity Health of New England Provider Network Organization Inc

  • Internal Medicine Physician
  • Waterville, ME
  • NPI 1134779531
  NPD
• Mercy Medical Group, Inc.

  • Internal Medicine Physician
  • Springfield, MA
  • NPI 1316213143
  NPD (past)

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

• Saint Mary'S Hospital, Inc.

  • General Acute Care Hospital
  • Waterbury, CT
  • NPI 1760426969

  Hospital

  Care Compare affiliation

Specialty

Physician Assistant

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Trinity Health of New England Provider Network Organization Inc 644 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Saint Mary'S Hospital Hospital, Waterbury, CT, CCN 070016

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

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: drackliffe2388594@direct.trinity-health.org

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 28, 2021.

{
    "created_epoch": "1136332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635379200000",
    "number": "1710965397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 NORTH MAIN STREET",
            "address_2": "SUITE 100",
            "city": "BRISTOL",
            "state": "CT",
            "postal_code": "06010",
            "telephone_number": "860-582-3942",
            "fax_number": "860-584-6529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 N MAIN ST",
            "address_2": "SUITE 100",
            "city": "BRISTOL",
            "state": "CT",
            "postal_code": "060104972",
            "telephone_number": "860-582-3942",
            "fax_number": "860-584-6529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RACKLIFFE",
        "first_name": "DOREEN",
        "middle_name": "A.",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-04",
        "last_updated": "2021-10-28",
        "certification_date": "2021-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "000825",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "drackliffe60139@direct.stfranciscare.org",
            "affiliation": "N",
            "endpointDescription": "CT Direct email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "70 Heminway Park Rd",
            "city": "Watertown",
            "state": "CT",
            "country_code": "US",
            "postal_code": "067952612",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• All providers in Bristol, CT
• Medical Physician Assistant in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2021; 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.

Verify at the official NPI Registry.