Marissa Amber Van Hennik, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

001324 Issued in CT

Practice address

56 Franklin St
Waterbury, CT 06706-1221

Phone

(203) 709-6004

Fax

(203) 709-3700

NPI assigned

Jul 10, 2006

Last updated

Sep 12, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Physician Assistant

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Urgent Care Medical Center LLCGroup PAC ID 0840570628, 52 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Urgent Care Medical Center LLC

  dba Priority Urgent Care

  • Urgent Care Clinic/Center
  • Ellington, CT
  • NPI 1295186286
  Medicare reassignment Care Compare group NPD
• Prohealth Physicians PC

  • Family Medicine Physician
  • Farmington, CT
  • NPI 1720194053
  Medicare reassignment
• Franklin Medical Group, PC

  dba Trinity Health Of New England Medical Group

  • Internal Medicine Physician
  • Waterbury, CT
  • NPI 1780686964
  NPD (past)
• Long River Physicians, LLC

  • Internal Medicine Physician
  • Naugatuck, CT
  • NPI 1912241589
  NPD (past)
• Midstate Medical Group, PC

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Meriden, CT
  • NPI 1356361315
  NPD (past)

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1189555200000",
    "number": "1740213727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "56 FRANKLIN ST",
            "address_2": "3RD FLOOR",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067061221",
            "telephone_number": "203-709-8873",
            "fax_number": "203-709-8689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56 FRANKLIN ST",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067061221",
            "telephone_number": "203-709-6004",
            "fax_number": "203-709-3700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN HENNIK",
        "first_name": "MARISSA",
        "middle_name": "AMBER",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-10",
        "last_updated": "2007-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "001324",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Asia Laray Valle
• Morgan Vallee, OTA
• Carmen Amada Vallerie, BS
• Gerald A Valletta, MD
• Valley Wellness Consulting Group LLC
• Jacqueline M Vargas, AS
• Velmary Vargas, LADC
• Ellise Vasquez, BS
• Omayra Vasquez, LMSW
• Brenda Vazquez

• Medical Physician Assistant in Waterbury, CT
• Providers in Waterbury, CT by specialty
• Medical Physician Assistant in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2007; 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.