Individual provider Active NPI

Lisa M Vanty, P.A.

  • Medical Physician Assistant
  • Wethersfield, CT
National Provider Identifier
1811097520
Registry record updated Jan 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
000150 Issued in CT
Practice address
1025 Silas Deane Hwy
Wethersfield, CT 06109-4229
Phone
(860) 696-2400
Fax
(860) 696-2410
NPI assigned
Sep 23, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2010

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 000150 CT Primary

Addresses

Primary practice location

1025 Silas Deane Hwy
Wethersfield, CT 06109-4229

Mailing address

1025 Silas Deane Hwy
Wethersfield, CT 06109-4229
Phone (860) 696-2400

Other identifiers 1

IdentifierTypeStateIssuer
1811097520OtherCTNPI

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
I20040817000147 CT Practitioner - Physician Assistant 4486627619 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
000150CTMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Hartford Healthcare Medical Group, Inc CurrentSince Jan 1, 2013 Accepting new patients
Hartford Physician Services PC Past Accepting new patients

Locations

55 Meriden Ave
Ste 1D
Southington, CT 06489
Phone (860) 276-5144

1025 Silas Deane Hwy
Wethersfield, CT 06109
Phone (860) 696-2296

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.

NPI Registry JSON

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

{
    "created_epoch": "1158969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1263254400000",
    "number": "1811097520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 SILAS DEANE HWY",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061094229",
            "telephone_number": "860-696-2400",
            "fax_number": "860-696-2410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 SILAS DEANE HWY",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061094229",
            "telephone_number": "860-696-2400",
            "fax_number": "860-696-2410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANTY",
        "first_name": "LISA",
        "middle_name": "M",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-23",
        "last_updated": "2010-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "000150",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1811097520",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wethersfield, CT

Sources for this page

Verify at the official NPI Registry.