NPIMap

Individual provider Active NPI

Sara Marie Miceli, PA-C

  • Physician Assistant
  • Prospect, CT
National Provider Identifier
1992131676
Registry record updated Oct 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2983 Issued in CT
Practice address
166 Waterbury Rd Ste 104
Prospect, CT 06712-1246
Phone
(203) 756-6422
NPI assigned
Sep 25, 2013
Last updated
Oct 28, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2983 CT Primary

Addresses

Primary practice location

166 Waterbury Rd Ste 104
Prospect, CT 06712-1246

Mailing address

166 Waterbury Rd Ste 104
Prospect, CT 06712-1246
Phone (203) 756-6422

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address smiceli225538@direct.stfranciscare.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140128000634 CT Practitioner - Physician Assistant 9739318593 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

114 Woodland St
Hartford, CT 06105-1208

166 Waterbury Rd
Suite 300
Prospect, CT 06712-1246
Phone (203) 709-5300

58 Maple St
Naugatuck, CT 06770-4160
Phone (203) 709-5935

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
2983CTMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Yale University CurrentSince Apr 22, 2021 Accepting new patients
Trinity Health of New England Provider Network Organization Inc CurrentSince Mar 27, 2022 Accepting new patients
Yale University CurrentSince Apr 22, 2021 Accepting new patients
Cep America LLC CurrentSince Apr 7, 2025 Accepting new patients
Cep America LLC CurrentSince Apr 7, 2025 Accepting new patients
Mercy Medical Group, Inc. Past Accepting new patients

Locations

2100 Powell St
Ste 400
Emeryville, CA 94608
Phone (510) 350-2638

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 350-2663

114 Woodland St
Hartford, CT 06105
Phone (860) 714-4001

58 Maple St
Ste 2
Naugatuck, CT 06770
Phone (203) 709-5935

800 Howard Ave
New Haven, CT 06519
Phone (203) 785-2140

Interoperability endpoints

  • Direct secure messaging: smiceli2389962@direct.trinity-health.org

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1380067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635379200000",
    "number": "1992131676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "166 WATERBURY RD STE 104",
            "city": "PROSPECT",
            "state": "CT",
            "postal_code": "067121246",
            "telephone_number": "203-756-6422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "166 WATERBURY RD STE 104",
            "city": "PROSPECT",
            "state": "CT",
            "postal_code": "067121246",
            "telephone_number": "203-756-6422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICELI",
        "first_name": "SARA",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-25",
        "last_updated": "2021-10-28",
        "certification_date": "2021-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "2983",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "smiceli225538@direct.stfranciscare.org",
            "affiliation": "N",
            "endpointDescription": "CT Direct email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "166 Waterbury Rd Ste 104",
            "city": "Prospect",
            "state": "CT",
            "country_code": "US",
            "postal_code": "067121246",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Prospect, CT

Sources for this page

Verify at the official NPI Registry.