Individual provider Active NPI

Janelle Shield Manton, MD

  • Dermatology Physician
  • Glastonbury, CT
National Provider Identifier
1841267986
Registry record updated Mar 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
044052 Issued in CT
Practice address
210 New London Turn Pike
Glastonbury, CT 06033-2235
Phone
(860) 633-1543
Fax
(860) 659-9755
NPI assigned
Mar 8, 2006
Last updated
Mar 30, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 044052 CT Primary

Addresses

Primary practice location

210 New London Turn Pike
Glastonbury, CT 06033-2235

Mailing address

210 New London Turn Pike
Glastonbury, CT 06033-2235
Phone (860) 633-1543

Other names 1

  • Janelle Shield Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jmanton@dagdermdocs.ezderm.info

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060724000305 CT Practitioner - Dermatology 5890708556 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Jefferson Medical College of Thomas Jefferson University, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dermatology Associates of Glastonbury LLCGroup PAC ID 2769373372, 5 clinicians

Practice addresses (Care Compare)

210 New London Tpke
Glastonbury, CT 06033-2235
Phone (860) 633-1543

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions654
Skin biopsy257

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
044052CTMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dermatology Associates of Glastonbury LLC Dermatology CurrentSince Jul 1, 2006 Accepting new patients

Locations

210 New London Tpke
Glastonbury, CT 06033
Phone (860) 633-1543

Interoperability endpoints

  • Direct secure messaging: jmanton@dagdermdocs.ezderm.info

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617062400000",
    "number": "1841267986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 NEW LONDON TURN PIKE",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060332235",
            "telephone_number": "860-633-1543",
            "fax_number": "860-659-9755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 NEW LONDON TURN PIKE",
            "city": "GLASTONBURY",
            "state": "CT",
            "postal_code": "060332235",
            "telephone_number": "860-633-1543",
            "fax_number": "860-659-9755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANTON",
        "first_name": "JANELLE",
        "middle_name": "SHIELD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-08",
        "last_updated": "2021-03-30",
        "certification_date": "2021-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CT",
            "license": "044052",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jmanton@dagdermdocs.ezderm.info",
            "affiliation": "N",
            "address_1": "210 New London Turn Pike",
            "city": "Glastonbury",
            "state": "CT",
            "country_code": "US",
            "postal_code": "060332235",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JANELLE",
            "last_name": "SHIELD",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Glastonbury, CT

Sources for this page

Verify at the official NPI Registry.