Individual provider Active NPI

Robert Jerry Petrillo, DO

  • Anesthesiology Physician
  • Hartford, CT
National Provider Identifier
1861953002
Registry record updated Sep 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
76176 Issued in CT
Practice address
80 Seymour St
Hartford, CT 06106-3300
Phone
(860) 545-5000
NPI assigned
Mar 29, 2019
Last updated
Sep 15, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 76176 CT Primary
Anesthesiology Physician 207L00000X 1013106 MA

Addresses

Primary practice location

80 Seymour St
Hartford, CT 06106-3300

Mailing address

100 Retreat Ave Ste 900
Hartford, CT 06106-2553
Phone (860) 218-2204

Other practice location 1

41 Mall Rd
Burlington, MA 01805-0001
Phone (781) 744-8000

Other practice location 2

263 Farmington Ave
Farmington, CT 06030-0001
Phone (860) 679-3600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, CT2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20230601000737 MA Practitioner - Anesthesiology 3375873482 Reassigns benefits to 1 organization
I20240531002599 CT Practitioner - Anesthesiology 3375873482 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2019
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)

326 Washington St
Norwich, CT 06360-2740
Phone (860) 282-0833

65 Memorial Rd
Suite 500
West Hartford, CT 06107-4233
Phone (860) 586-8655

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

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.98 of 100Reported as apm
Quality
76.59
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
76176CTMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lahey Clinic, Inc CurrentSince Apr 1, 2023 Accepting new patients
Integrated Anesthesia Associates LLC Anesthesiology CurrentSince May 1, 2024 Accepting new patients

Locations

100 Retreat Ave
Ste 900
Hartford, CT 06106
Phone (860) 218-2204

80 Seymour St
Hartford, CT 06106
Phone (860) 545-2249

99 E River Dr
Fl 5
Hartford, CT 06108
Phone (860) 282-4022

41 Mall Rd
Burlington, MA 01805
Phone (781) 744-8400

Interoperability endpoints

  • Direct secure messaging: robert.petrillo@xdr.hhchealthdirect.org
  • Direct secure messaging: rpetrillo199771@direct.bilh.masshiway.net

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1553817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726358400000",
    "number": "1861953002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 RETREAT AVE STE 900",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061062553",
            "telephone_number": "860-218-2204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 SEYMOUR ST",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061063300",
            "telephone_number": "860-545-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "41 Mall Rd",
            "address_purpose": "LOCATION",
            "city": "Burlington",
            "state": "MA",
            "postal_code": "018050001",
            "country_code": "US",
            "telephone_number": "781-744-8000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "263 Farmington Ave",
            "address_purpose": "LOCATION",
            "city": "Farmington",
            "state": "CT",
            "postal_code": "060300001",
            "country_code": "US",
            "telephone_number": "860-679-3600",
            "fax_number": "860-679-1275",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETRILLO",
        "first_name": "ROBERT",
        "middle_name": "JERRY",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-29",
        "last_updated": "2024-09-15",
        "certification_date": "2024-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CT",
            "license": "76176",
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MA",
            "license": "1013106",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hartford, CT

Sources for this page

Verify at the official NPI Registry.