Individual provider Active NPI

Jennifer L Gordon, P.A.

  • Physician Assistant
  • East Hartford, CT
National Provider Identifier
1740388552
Registry record updated May 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0000022 Issued in CT
Practice address
99 E River Dr
5TH Floor
East Hartford, CT 06108-3288
Phone
(860) 282-4022
Fax
(860) 289-0746
NPI assigned
Sep 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0000022 CT Primary

Addresses

Primary practice location

99 E River Dr
5TH Floor
East Hartford, CT 06108-3288

Mailing address

99 E River Dr
5TH Floor
East Hartford, CT 06108-3288
Phone (860) 282-4022

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110205000002 CT Practitioner - Physician Assistant 7315127552 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Integrated Anesthesia Associates LLCGroup PAC ID 1759281165, 402 clinicians

Practice addresses (Care Compare)

80 Semour St
Hartford, CT 06106-3315
Phone (860) 972-2117

Hospital & facility affiliations

  • Hartford Hospital Hospital, Hartford, CT, CCN 070025

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0000022CTMDPhysician Assistant
000022CTMDAdvanced Practice Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
Hartford Anesthesiology Associates, Inc. Past Accepting new patients

Organizations & group practices 2

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1399334400000",
    "number": "1740388552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 E RIVER DR",
            "address_2": "5TH FLOOR",
            "city": "EAST HARTFORD",
            "state": "CT",
            "postal_code": "061083288",
            "telephone_number": "860-282-4022",
            "fax_number": "860-289-0746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 E RIVER DR",
            "address_2": "5TH FLOOR",
            "city": "EAST HARTFORD",
            "state": "CT",
            "postal_code": "061083288",
            "telephone_number": "860-282-4022",
            "fax_number": "860-289-0746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORDON",
        "first_name": "JENNIFER",
        "middle_name": "L",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2014-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "0000022",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Hartford, CT

Sources for this page

Verify at the official NPI Registry.