Active NPI
Diana G Poulsen
- Medical Physician Assistant
- New Haven, CT
National Provider Identifier
1962872523
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 4174
- Practice address
- Yale New Haven Pediatric Ed
1 Park St
New Haven, CT 06504 - Phone
- (203) 688-4242
- NPI assigned
- Sep 25, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | CT | ||
| Medical Physician Assistant | 363AM0700X | 4174 | CT | Primary |
Addresses
Primary practice location
Yale New Haven Pediatric Ed
1 Park St
New Haven, CT 06504
Mailing address
177 Candlewood Rd
Fairfield, CT 06825-3662
Other practice location 1
15 W Main St # C201
Norwalk, CT 06851
Phone (508) 314-0044
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4174 | CT | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Yale University | Current | Accepting new patients | |
| Yale University | Current | Accepting new patients |
Locations
800 Howard Ave
New Haven, CT 06519
Phone (203) 785-2140
1 Park St
North Haven, CT 06504
Phone (203) 785-4643
Interoperability endpoints
- dpoulsen436148@direct.ynhh.org
Organizations & group practices 7
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.
-
- Urgent Care Clinic/Center
- Bridgeport, CT
- NPI 1487087250
-
- Adult Mental Health Clinic/Center
- Hamden, CT
- NPI 1134391824
-
- Durable Medical Equipment & Medical Supplies
- Fairfield, CT
- NPI 1548066962
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1443139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566259200000",
"number": "1962872523",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "177 CANDLEWOOD RD",
"city": "FAIRFIELD",
"state": "CT",
"postal_code": "068253662"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "YALE NEW HAVEN PEDIATRIC ED",
"address_2": "1 PARK ST",
"city": "NEW HAVEN",
"state": "CT",
"postal_code": "06504",
"telephone_number": "203-688-4242"
}
],
"practiceLocations": [
{
"address_1": "15 W Main St # C201",
"address_purpose": "LOCATION",
"city": "Norwalk",
"state": "CT",
"postal_code": "06851",
"country_code": "US",
"telephone_number": "508-314-0044",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "POULSEN",
"first_name": "DIANA",
"middle_name": "G",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-09-25",
"last_updated": "2019-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CT",
"license": null,
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "CT",
"license": "4174",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Haven, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.