Healthcare Provider Details

I. General information

NPI: 1609890698
Provider Name (Legal Business Name): JESSE E HILL PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 JOLLEY DRIVE
BLOOMFIELD CT
06002
US

IV. Provider business mailing address

47 JOLLEY DR
BLOOMFIELD CT
06002-3092
US

V. Phone/Fax

Practice location:
  • Phone: 860-243-3020
  • Fax: 860-243-3002
Mailing address:
  • Phone: 860-243-3020
  • Fax: 860-243-3002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number000178
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier001167568
Identifier TypeMEDICAID
Identifier StateCT
Identifier Issuer
# 2
Identifier290000178CT01
Identifier TypeOTHER
Identifier StateCT
Identifier IssuerBLUE CROSS/BLUE SHIELD
# 3
Identifier44259
Identifier TypeOTHER
Identifier StateCT
Identifier IssuerAETNA US HEALTHCARE
# 4
Identifier18000
Identifier TypeOTHER
Identifier StateCT
Identifier IssuerCONNECTICARE
# 5
IdentifierP1595383
Identifier TypeOTHER
Identifier StateCT
Identifier IssuerOXFORD HEALTH PLANS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: