Individual provider Active NPI

Brandon Ito, PA-C

  • Physician Assistant
  • Meriden, CT
National Provider Identifier
1962022129
Registry record updated Oct 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5422 Issued in CT
Practice address
455 Lewis Ave Ste 221
Meriden, CT 06451-2121
Phone
(203) 694-8550
Fax
(203) 694-7698
NPI assigned
Apr 17, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2021

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 5422 CT Primary

Addresses

Primary practice location

455 Lewis Ave Ste 221
Meriden, CT 06451-2121

Mailing address

1290 Silas Deane Hwy
Hartford Healthcare-Cvo
Wethersfield, CT 06109-4337

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
I20211102000951 CT Practitioner - Physician Assistant 9638567142 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hartford Healthcare Medical Group Specialists PLLCGroup PAC ID 3173866241, 1,555 clinicians

Practice addresses (Care Compare)

1244 Storrs Rd
Road
Storrs, CT 06268-2200
Phone (860) 724-2579

1290 Silas Deane Hwy
Wethersfield, CT 06109-4337
Phone (860) 827-7695

435 Lewis Ave
Meriden, CT 06451-2101

Hospital & facility affiliations

  • Midstate Medical Center Hospital, Meriden, CT, CCN 070017
  • Hartford Hospital Hospital, Hartford, CT, CCN 070025

Merit-based Incentive Payment System (MIPS)

Final score
90.42 of 100Reported as group
Quality
83.36
Promoting interoperability
100
Improvement activities
40
Cost
75.9

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Hartford Healthcare Medical Group Specialists LLC CurrentSince Dec 6, 2021 Accepting new patients
Hartford Healthcare Medical Group Specialists, PLLC CurrentSince Dec 6, 2021 Accepting new patients

Locations

455 Lewis Ave
Ste 221
Meriden, CT 06451
Phone (203) 694-7595

1244 Storrs Rd
Storrs Mansfield, CT 06268
Phone (860) 724-2579

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

Interoperability endpoints

  • Direct secure messaging: brandon.ito@xdr.hhchealthdirect.org

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 4

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": "1587081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635292800000",
    "number": "1962022129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1290 SILAS DEANE HWY",
            "address_2": "HARTFORD HEALTHCARE-CVO",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "061094337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 LEWIS AVE STE 221",
            "city": "MERIDEN",
            "state": "CT",
            "postal_code": "064512121",
            "telephone_number": "203-694-8550",
            "fax_number": "203-694-7698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ITO",
        "first_name": "BRANDON",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-17",
        "last_updated": "2021-10-27",
        "certification_date": "2021-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "5422",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meriden, CT

Sources for this page

Verify at the official NPI Registry.