MR. JASON D ANDRUS PA NPI 1104808369

NPI Information

NPI: 1104808369
Provider Name: MR. JASON D ANDRUS, PA
Classification: Physician Assistant - 363AS0400X
Entity Type: Individual

Specialization: Surgical

Organization: MIDSTATE MEDICAL CENTER

PECOS Registration: Yes

Address:
1450 CHAPEL ST
HOSPITAL OF SAINT RAPHAEL, DEPARTMENT OF SURGERY
NEW HAVEN, CT
ZIP 06511
Phone: (203) 789-3501
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MR. Jason D Andrus, PA is a surgical physician assistant in New Haven, CT with 26 years of experience. MR. Jason D Andrus, PA NPI is 1104808369. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1450 CHAPEL ST
HOSPITAL OF SAINT RAPHAEL, DEPARTMENT OF SURGERY
NEW HAVEN, CT
ZIP 06511-405
Phone: (203) 789-3501

The NPI 1104808369 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 11/15/2005 and was last updated on 7/4/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AS0400X	Physician Assistant	Surgical	001011	CONNECTICUT	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	P24657	MEDICARE UPIN
2	970001179	MEDICARE ID-TYPE UNSPECIFIED
3	P00461315	OTHER	CONNECTICUT	RAILROAD MEDICARE PROVIDER NUMBER
4	970002460	MEDICARE PIN	CONNECTICUT
5	1104808369	OTHER		NPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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