ELISE MAE FERNSTROM
NPI 1083411904
Nurse Practitioner - Psychiatric/Mental Health in Norwich, CT

Q: What is Elise Fernstrom's NPI number?

The NPI number for Elise Fernstrom is 1083411904. It was assigned to this individual provider in the NPPES registry on February 27, 2025.

Q: What is Elise Fernstrom's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Q: When was this NPI record last updated?

The NPPES record for Elise Fernstrom was last updated on February 27, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since February 27, 2025PECOS EnrolledAccepts Medicare Assignment

401 W THAMES ST BLDG 301, NORWICH, CT 06360(860) 859-4563 Get Directions Write a Review

NPPES record last updated: February 27, 2025. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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About Elise Mae Fernstrom NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ELISE MAE FERNSTROM (NPI 1083411904) is an individual psychiatric/mental health provider in Norwich, Connecticut, licensed in Connecticut (14409) and active in the NPI registry since February 2025. She is enrolled in Medicare PECOS and is a graduate of Other (2024).

NPPES Registry Identity

NPI1083411904

Entity TypeIndividualFemale

Primary Taxonomy363LP0808X

Provider Legal NameELISE MAE FERNSTROM

Location Address401 W THAMES ST BLDG 301Norwich, CT 06360-7155

Mailing Address122 Brooklyn RdPomfret Center, CT 06259-2404 · (860) 250-6210

Phone(860) 859-4563

Sole ProprietorNo

Medical School CMSOtherGraduated 2024

Enumeration DateFebruary 27, 2025

NPPES CertifiedFebruary 27, 2025

✔ NPI 1083411904 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0808X

License✔ Licensed in CT · 14409

401 W THAMES ST BLDG 301, Norwich, CT 06360

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Elise Mae Fernstrom is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID3173534914

PECOS Enrollment IDI20250930001646

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 06360 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$93.86 typical visit price

range $60.82 – $183.10

Typical copayment $23.46 (range $15.20 – $45.77)

Most-billed visit code 99203

Established Patient

$106.68 typical visit price

range $19.76 – $149.26

Typical copayment $26.67 (range $4.94 – $37.31)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 15

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. MICHAEL JAMES MAGALDI LCSW

Social Worker (Clinical)