Individual provider Active NPI

Sarah Dallaire Roncaioli, PA-C

  • Physician Assistant
  • Hartford, CT
National Provider Identifier
1992472450
Registry record updated Jun 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
23.005339 Issued in CT
Practice address
21 Grand St
Hartford, CT 06106-1541
Phone
(860) 550-7500
NPI assigned
Aug 24, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 5339 CT
Physician Assistant 363A00000X 23.005339 CT Primary

Addresses

Primary practice location

21 Grand St
Hartford, CT 06106-1541

Mailing address

1036R Suffield St
Agawam, MA 01001-2931
Phone (860) 324-3867

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
I20210921002654 CT Practitioner - Physician Assistant 7618374406 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5339CTMDFamily Medicine Physician
23.005339CTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Optimus Health Care CurrentSince Sep 1, 2021 Accepting new patients
Community Health Center Inc CurrentSince Jun 11, 2024 Accepting new patients
Optimus Health Care Inc CurrentSince Sep 1, 2021 Accepting new patients
Community Health Center Inc Family Medicine CurrentSince Jun 11, 2024 Accepting new patients
Charter Oak Health Center, Inc. CurrentSince Jun 20, 2022 Accepting new patients
Charter Oak Health Center, Inc. CurrentSince Jun 20, 2022 Accepting new patients

Locations

982 E Main St
Bridgeport, CT 06608
Phone (203) 696-3260

471 Barnum Ave
Bridgeport, CT 06608
Phone (203) 333-6864

21 Grand St
Hartford, CT 06106

805 Atlantic St
Stamford, CT 06902
Phone (203) 327-5111

Interoperability endpoints

  • Direct secure messaging: sarah.roncaioli@chcict.eclinicaldirectplus.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1629763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655856000000",
    "number": "1992472450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1036R SUFFIELD ST",
            "city": "AGAWAM",
            "state": "MA",
            "postal_code": "010012931",
            "telephone_number": "860-324-3867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 GRAND ST",
            "city": "HARTFORD",
            "state": "CT",
            "postal_code": "061061541",
            "telephone_number": "860-550-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RONCAIOLI",
        "first_name": "SARAH",
        "middle_name": "DALLAIRE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-24",
        "last_updated": "2022-06-22",
        "certification_date": "2022-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CT",
            "license": "5339",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "23.005339",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hartford, CT

Sources for this page

Verify at the official NPI Registry.