Active NPI
Matthew Vance Pennacchia
- Physician Assistant
- Orange, CT
National Provider Identifier
1982287538
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5310
- Practice address
- 521 Boston Post Rd
Orange, CT 06477-3506 - Phone
- (203) 529-3271
- NPI assigned
- May 2, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5310 | CT | Primary |
Addresses
Primary practice location
521 Boston Post Rd
Orange, CT 06477-3506
Mailing address
1700 Broadbridge Ave Unit B27
Stratford, CT 06614-5493
Phone (203) 722-3028
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hartford Healthcare Medical Group, Inc | Single Specialty | Current | Accepting new patients |
| Hartford Healthcare Medical Group Specialists LLC | Current | Accepting new patients | |
| Hartford Healthcare Medical Group Specialists, PLLC | Single Specialty | Current | Accepting new patients |
Locations
55 Meriden Ave
Ste 1D
Southington, CT 06489
Phone (860) 276-5144
1244 Storrs Rd
Storrs Mansfield, CT 06268
Phone (860) 724-2579
1290 Silas Deane Hwy
Wethersfield, CT 06109
Phone (860) 972-6977
Interoperability endpoints
- matthew.pennacchia@xdr.hhchealthdirect.org
Organizations & group practices 6
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.
-
- Surgery Physician
- Hartford, CT
- NPI 1023584216
Single Specialty
-
- Surgery Physician
- Wethersfield, CT
- NPI 1043561301
Single Specialty
-
- Customized Equipment (DME)
- Groton, CT
- NPI 1295367068
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1619913600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1633910400000",
"number": "1982287538",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1700 BROADBRIDGE AVE UNIT B27",
"city": "STRATFORD",
"state": "CT",
"postal_code": "066145493",
"telephone_number": "203-722-3028"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "521 BOSTON POST RD",
"city": "ORANGE",
"state": "CT",
"postal_code": "064773506",
"telephone_number": "203-529-3271"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENNACCHIA",
"first_name": "MATTHEW",
"middle_name": "VANCE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-05-02",
"last_updated": "2021-10-11",
"certification_date": "2021-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Physician Assistant",
"state": "CT",
"license": "5310",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orange, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2021; 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.