Active NPI
Colleen Booth, PA-C
- Physician Assistant
- Manchester, CT
National Provider Identifier
1972022135
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 3964
- Practice address
- 71 Haynes St
Manchester, CT 06040-4131 - Phone
- (860) 646-1222
- NPI assigned
- Sep 19, 2017
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 3964 | CT | |
| Physician Assistant | 363A00000X | 3964 | CT | Primary |
Addresses
Primary practice location
71 Haynes St
Manchester, CT 06040-4131
Mailing address
104 Pitkin St
Manchester, CT 06040-4456
Phone (860) 685-0816
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA, NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220328002108 | MA | Practitioner - Physician Assistant | 9931475449 | Reassigns benefits to 2 organizations |
| I20260505000404 | NY | Practitioner - Physician Assistant | 9931475449 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2017
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
700 Hicksville Rd
Bethpage, NY 11714-3471
Hospital & facility affiliations
- NYU Langone Hospitals
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mass General Brigham Urgent Care LLC | Current | Accepting new patients | |
| Mass General Brigham Urgent Care LLC | Current | Accepting new patients | |
| Eastern Connecticut Medical Professionals Foundation, Inc | Past | Accepting new patients |
Locations
1285 Beacon St
Brookline, MA 02446
Phone (617) 751-6205
Interoperability endpoints
- cbooth144070@nyumc.direct-ci.com
- cbooth18024@middlesexhealthprd.direct-ci.com
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.
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- Boston, MA
- NPI 1033535497
MA
-
- Urgent Care Clinic/Center
- Cambridge, MA
- NPI 1609387695
-
- Specialist
- South Windsor, CT
- NPI 1497864516
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": "1505779200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1539734400000",
"number": "1972022135",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "104 PITKIN ST",
"city": "MANCHESTER",
"state": "CT",
"postal_code": "060404456",
"telephone_number": "860-685-0816"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "71 HAYNES ST",
"city": "MANCHESTER",
"state": "CT",
"postal_code": "060404131",
"telephone_number": "860-646-1222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOOTH",
"first_name": "COLLEEN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-09-19",
"last_updated": "2018-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "CT",
"license": "3964",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CT",
"license": "3964",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manchester, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2018; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.