Individual provider Active NPI

Jennifer L Muller, APRN

  • Neonatal Nurse Practitioner
  • Middletown, CT
National Provider Identifier
1982690202
Registry record updated Dec 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal Nurse PractitionerTaxonomy code 363LN0000X
License
005180 Issued in CT
Practice address
28 Crescent St
Middletown, CT 06457-3654
Phone
(860) 358-6394
Fax
(860) 358-6748
NPI assigned
Sep 22, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2012

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X C089082 IA
Neonatal Nurse Practitioner 363LN0000X K089082 IA
Neonatal Nurse Practitioner 363LN0000X 005180 CT Primary
Pediatric Nurse Practitioner 363LP0200X 005180 CT
Registered Nurse 163W00000X 108351 CT

Addresses

Primary practice location

28 Crescent St
Middletown, CT 06457-3654

Mailing address

28 Crescent St
Middletown, CT 06457-3654
Phone (860) 358-6394

Other identifiers 2

IdentifierTypeStateIssuer
0421040MedicaidIA
31674OtherIAWELLMARK BCBS

Other names 1

  • Jennifer L Bridgman Former name

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130424000377 CT Practitioner - Nurse Practitioner 2668597618 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
108351CTMDRegistered Nurse
005180CTMDMedical Physician Assistant
C089082IAMDNurse Practitioner
K089082IAMDNeonatal Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Middlesex Hospital Current Accepting new patients
Middlesex Hospital Nurse Practitioner Current Accepting new patients
Middlesex Hospital Nurse Practitioner CurrentSince Jan 7, 2013 Accepting new patients
Connecticut Pathology Group PC Current Accepting new patients
Middlesex Hospital CurrentSince Jan 7, 2013 Accepting new patients

Locations

90 S Main St
Middletown, CT 06457
Phone (860) 358-6300

28 Crescent St
Middletown, CT 06457
Phone (860) 358-6000

Interoperability endpoints

  • Direct secure messaging: jmuller14530@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.

NPI Registry JSON

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

{
    "created_epoch": "1127347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355097600000",
    "number": "1982690202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 CRESCENT ST",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064573654",
            "telephone_number": "860-358-6394",
            "fax_number": "860-358-6748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 CRESCENT ST",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064573654",
            "telephone_number": "860-358-6394",
            "fax_number": "860-358-6748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLER",
        "first_name": "JENNIFER",
        "middle_name": "L",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-22",
        "last_updated": "2012-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IA",
            "license": "C089082",
            "primary": false
        },
        {
            "code": "363LN0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal",
            "state": "IA",
            "license": "K089082",
            "primary": false
        },
        {
            "code": "363LN0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal",
            "state": "CT",
            "license": "005180",
            "primary": true
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "CT",
            "license": "005180",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CT",
            "license": "108351",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0421040",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BCBS",
            "identifier": "31674",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "BRIDGMAN",
            "middle_name": "L",
            "credential": "RN LPN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Middletown, CT

Sources for this page

Verify at the official NPI Registry.