Jake Petillo

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

12761 Issued in CT

Practice address

100 Grand St
New Britain, CT 06052-2016

Phone

(860) 224-5011

NPI assigned

Jan 5, 2024

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Hospital of Central Connecticut at New Britain General and BradleyGroup PAC ID 6507776564, 396 clinicians

Midstate Medical CenterGroup PAC ID 7416840699, 187 clinicians

Hartford Healthcare Medical Group Specialists PLLCGroup PAC ID 3173866241, 1,555 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• The Hospital of Central Connecticut Hospital, New Britain, CT, CCN 070035
• Midstate Medical Center Hospital, Meriden, CT, CCN 070017

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Hartford Healthcare Medical Group Specialists, PLLC

  • Surgery Physician
  • Hartford, CT
  • NPI 1023584216

  Nurse Practitioner

  Medicare reassignment Care Compare group NPD
• Midstate Medical Center

  • General Acute Care Hospital
  • Meriden, CT
  • NPI 1154425288
  Medicare reassignment Care Compare group NPD
• The Hospital of Central Connecticut at New Britain General and Bradley

  • Hospitalist Physician
  • New Britain, CT
  • NPI 1063461481
  Medicare reassignment Care Compare group NPD
• Hartford Hospital

  • Surgery Physician
  • Hartford, CT
  • NPI 1407806391
  Medicare reassignment NPD
• Hartford Hospital

  • General Acute Care Hospital
  • Hartford, CT
  • NPI 1770696643
  Medicare reassignment NPD
• Hartford Healthcare Medical Group Specialists LLC

  • Customized Equipment (DME)
  • Groton, CT
  • NPI 1295367068
  NPD
• Midstate Medical Center

  • Psychiatric Hospital Unit
  • Meriden, CT
  • NPI 1316022718
  NPD
• Midstate Medical Center

  • General Acute Care Hospital
  • Meriden, CT
  • NPI 1427007848
  NPD
• The Hospital of Central Connecticut at New Britain General and Bradley

  • Psychiatric Hospital Unit
  • New Britain, CT
  • NPI 1992867006
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Midstate Medical Center

  • General Acute Care Hospital
  • Meriden, CT
  • NPI 1427007848
  Care Compare affiliation
• Midstate Medical Center

  • General Acute Care Hospital
  • Meriden, CT
  • NPI 1669524187
  Care Compare affiliation
• New Britain General Hospital

  • General Acute Care Hospital
  • New Britain, CT
  • NPI 1548225360
  Care Compare affiliation
• The Hospital of Central Connecticut at New Britain General and Bradley

  • General Acute Care Hospital
  • New Britain, CT
  • NPI 1053477075
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1704412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704412800000",
    "number": "1982474482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 W CENTER ST",
            "city": "SOUTHINGTON",
            "state": "CT",
            "postal_code": "064893550",
            "telephone_number": "203-217-3143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 GRAND ST",
            "city": "NEW BRITAIN",
            "state": "CT",
            "postal_code": "060522016",
            "telephone_number": "860-224-5011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETILLO",
        "first_name": "JAKE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-01-05",
        "last_updated": "2024-01-05",
        "certification_date": "2023-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CT",
            "license": "12761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sharon Perrott, LPC
• Marissa Persico, LPC
• Alexander Pescaru
• William James Pesce, D.O.
• Amiyah Peters
• William A. Petit Jr., MD
• Carrie Ann Petrow, PTA/L
• Eliza K Pezzulo, MFTA
• Hannah Pfeffer
• Jacquelyne Phanavong

• Nurse Practitioner in New Britain, CT
• Providers in New Britain, CT by specialty
• Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2024; 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.

Verify at the official NPI Registry.