ELISE MAE FERNSTROM
NPI 1083411904
Nurse Practitioner - Psychiatric/Mental Health in Norwich, CT
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
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
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.
Medicare Billing Reassignment
Medicare enrollment records show Elise Fernstrom reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Avon, CT 06001
- Reassigned Medicare billing, Connecticut enrollment
- 144 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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.
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.
NORWICH, CT 06360
NORWICH, CT 06360
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
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.
Where is Elise Fernstrom located?
Elise Fernstrom practices at 401 W Thames St Bldg 301, Norwich, CT 06360. The listed phone number is (860) 859-4563.
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.
Is Elise Fernstrom enrolled in Medicare?
Yes. Elise Fernstrom is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organization bills Medicare for Elise Fernstrom's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Elise Fernstrom reassigns Medicare benefits to Harvest Healthcare LLC (Avon, CT). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Elise Fernstrom's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Elise Fernstrom was last updated on February 27, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Elise Mae Fernstrom · NPI 1083411904
Psychiatric/Mental Health physician in Norwich, Connecticut. Individual provider, active in the CMS NPPES registry since February 27, 2025.
## Identity
- **NPI:** 1083411904 (Entity type: Individual)
- **Enumerated:** February 27, 2025
- **Primary specialty:** Nurse Practitioner - Psychiatric/Mental Health · taxonomy 363LP0808X
- **State license:** 14409 (Connecticut)
- **Sole proprietor:** No
## Practice location
- **Address:** 401 W THAMES ST BLDG 301, Norwich, CT 06360-7155
- **Phone:** (860) 859-4563
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Harvest Healthcare LLC (NPI 1477712917, Avon, CT), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2024
## Record status
- **NPPES last updated:** February 27, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1083411904) · Data from the CMS NPPES public registry.