NPIMap

Individual provider Active NPI

Lavina Jacob Gagnon, PA-C

  • Physician Assistant
  • Hartford, CT
National Provider Identifier
1962557207
Registry record updated Dec 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
011516 Issued in CT
Practice address
85 Seymour St
Suite 900
Hartford, CT 06106-5501
Phone
(860) 241-0700
Fax
(860) 525-7881
NPI assigned
Jan 25, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 011516 NY
Physician Assistant 363A00000X 011516 CT Primary

Addresses

Primary practice location

85 Seymour St
Suite 900
Hartford, CT 06106-5501

Mailing address

2110 Silas Deane Hwy
Rocky Hill, CT 06067-2313
Phone (860) 258-3480

Other identifiers 1

IdentifierTypeStateIssuer
011516OtherCTLICENSE

Other names 1

  • Ms. Lavina Jose Jacob Former 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
I20110525000497 CT Practitioner - Physician Assistant 2668658717 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Starling Physicians, PLLCGroup PAC ID 7517863749, 276 clinicians

Practice addresses (Care Compare)

100 Simsbury Rd
Avon, CT 06001-3793
Phone (860) 258-3480

1260 Silas Deane Hwy
Wethersfield, CT 06109-4362
Phone (860) 832-4666

Hospital & facility affiliations

  • Hartford Healthcare at Home Home health agency, East Hartford, CT, CCN 077041
  • The Hospital of Central Connecticut Hospital, New Britain, CT, CCN 070035
  • Hartford Hospital Hospital, Hartford, CT, CCN 070025

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2535CTMDMarriage & Family Therapist
011516CTMDPhysician Assistant
011516NYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Starling Physicians PLLC CurrentSince Jan 3, 2012 Accepting new patients
Starling Physicians, PLLC CurrentSince Jan 3, 2012 Accepting new patients
Starling Physicians, PLLC Past Accepting new patients
Heart Physicians, P.C. Past Accepting new patients
Stamford Health Medical Group Inc Past Accepting new patients

Locations

100 Simsbury Rd
Avon, CT 06001
Phone (860) 659-8830

85 Seymour St
Ste 900
Hartford, CT 06106
Phone (860) 241-0700

85 Seymour St
Ste 1019
Hartford, CT 06106
Phone (860) 246-4029

2110 Silas Deane Hwy
Rocky Hill, CT 06067

Interoperability endpoints

  • Direct secure messaging: lavina.gagnon@xdr.hhchealthdirect.org
  • FHIR API: https://fhir4.healow.com/fhir/r4/ABCIBA

Organizations & group practices 5

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 5

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": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324166400000",
    "number": "1962557207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2110 SILAS DEANE HWY",
            "city": "ROCKY HILL",
            "state": "CT",
            "postal_code": "060672313",
            "telephone_number": "860-258-3480",
            "fax_number": "860-571-6800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 SEYMOUR ST",
            "address_2": "SUITE 900",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061065501",
            "telephone_number": "860-241-0700",
            "fax_number": "860-525-7881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAGNON",
        "first_name": "LAVINA",
        "middle_name": "JACOB",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-25",
        "last_updated": "2011-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "011516",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "011516",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "011516",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAVINA",
            "last_name": "JACOB",
            "middle_name": "JOSE",
            "prefix": "MS.",
            "credential": "RPA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Hartford, CT

Sources for this page

Verify at the official NPI Registry.