NPIMap

Individual provider Active NPI

Samantha Doucette, APRN

  • Adult Health Nurse Practitioner
  • Mystic, CT
National Provider Identifier
1821735382
Registry record updated Aug 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
10814 Issued in CT
Practice address
100 Perkins Farm Dr
Mystic, CT 06355-4037
Phone
(860) 545-5000
NPI assigned
May 17, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X 109771 CT
Adult Health Nurse Practitioner 363LA2200X 10814 CT Primary

Addresses

Primary practice location

100 Perkins Farm Dr
Mystic, CT 06355-4037

Mailing address

100 Perkins Farm Dr Ste 203
Mystic, CT 06355-4041
Phone (860) 572-8911

Other names 1

  • Samantha Gagliardi Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220913002574 CT Practitioner - Nurse Practitioner 0345625240 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Hartford Healthcare Medical Group IncGroup PAC ID 1153573902, 257 clinicians

Practice addresses (Care Compare)

100 Perkins Farm Dr
Suite 203
Mystic, CT 06355-4041
Phone (860) 572-8911

Hospital & facility affiliations

  • Yale New Haven Health - Health at Home Southeast Home health agency, Waterford, CT, CCN 077015
  • Hartford Healthcare at Home Home health agency, East Hartford, CT, CCN 077041
  • Centerwell Home Health Home health agency, Rocky Hill, CT, CCN 077162
  • Masonicare Home Health & Hospice, Inc Home health agency, Wallingford, CT, CCN 077159
  • Lawrence & Memorial Hospital Hospital, New London, CT, CCN 070007
  • William W Backus Hospital Hospital, Norwich, CT, CCN 070024
  • Westerly Hospital Hospital, Westerly, RI, CCN 410013

Merit-based Incentive Payment System (MIPS)

Final score
94.48 of 100Reported as apm
Quality
83.4
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
10814CTMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Hartford Healthcare Medical Group, Inc CurrentSince Sep 1, 2022 Accepting new patients
Hartford Healthcare Medical Group Specialists, PLLC Past Accepting new patients
Hartford Healthcare Medical Group, Inc PastSince Aug 28, 2022 Accepting new patients

Locations

100 Perkins Farm Dr
Ste 203
Mystic, CT 06355
Phone (201) 787-1446

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

1290 Silas Deane Hwy
Wethersfield, CT 06109
Phone (860) 972-6977

Interoperability endpoints

  • Direct secure messaging: samantha.doucette@xdr.hhchealthdirect.org

Organizations & group practices 3

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 10

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": "1652745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661385600000",
    "number": "1821735382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 PERKINS FARM DR STE 203",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "063554041",
            "telephone_number": "860-572-8911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 PERKINS FARM DR",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "063554037",
            "telephone_number": "860-545-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUCETTE",
        "first_name": "SAMANTHA",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-17",
        "last_updated": "2022-08-25",
        "certification_date": "2022-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "CT",
            "license": "109771",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CT",
            "license": "10814",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAMANTHA",
            "last_name": "GAGLIARDI",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Mystic, CT

Sources for this page

Verify at the official NPI Registry.