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REBECCA BELLA FORMAN
NPI 1124683651
Student in an Organized Health Care Education/Training Program in New Haven, CT

Active since May 09, 2019PECOS EnrolledAccepts Medicare Assignment
20 YORK ST, NEW HAVEN, CT 06510(203) 688-4242 Get Directions Write a Review

NPPES record last updated: May 9, 2019. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Rebecca Bella Forman NPPES

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

REBECCA BELLA FORMAN (NPI 1124683651) is an individual student in an organized health care education/training program in New Haven, Connecticut and active in the NPI registry since May 2019. She is enrolled in Medicare PECOS, is affiliated with Hospital Of Univ Of Pennsylvania, and is a graduate of Other (2019).

NPPES Registry Identity

NPI1124683651
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameREBECCA BELLA FORMAN
Location Address20 YORK STNew Haven, CT 06510-3220
Mailing Address20 York StNew Haven, CT 06510-3220 · (203) 688-4242
Phone(203) 688-4242
Sole ProprietorNo
Medical School CMSOtherGraduated 2019
Enumeration DateMay 9, 2019
✔ NPI 1124683651 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
20 YORK ST, New Haven, CT 06510
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Other Names 1

Former Name (1)Rebecca Bella Gross

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

Rebecca Bella Forman 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 ID8426382250
PECOS Enrollment IDI20250820004314
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.

Hospital Affiliations CMS Care Compare 3

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Hospital Of Univ Of Pennsylvania

Acute Care Hospitals · Philadelphia, PA
5/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number390111
Location34th & Spruce StsPhiladelphia, PA 19104 · Philadelphia County
Emergency services Birthing friendly

Penn Presbyterian Medical Center

Acute Care Hospitals · Philadelphia, PA
5/5 CMS rating
OwnershipVoluntary non-profit - Other
CMS Certification Number390223
Location51 North 39th StreetPhiladelphia, PA 19104 · Philadelphia County
Emergency services

Pennsylvania Hospital

Acute Care Hospitals · Philadelphia, PA
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number390226
Location800 Spruce StreetPhiladelphia, PA 19107 · Philadelphia County
Emergency services Birthing friendly

Other Providers at the Same Location NPPES 20

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

AUDREY P SENIOR APRN
Nurse Practitioner (Family)
20 YORK ST
NEW HAVEN, CT 06510
South Central Connecticut Planning Region (203) 688-5860
DR. YEISID F FIGUEREDO M.D.
Pediatrics (Neonatal-Perinatal Medicine)
20 YORK ST, DEPT OF NEONATOLOGY
NEW HAVEN, CT 06510
South Central Connecticut Planning Region (203) 688-2320
YALE NEW HAVEN HOSPITAL
Durable Medical Equipment & Medical Supplies (Customized Equipment)
20 YORK ST
NEW HAVEN, CT 06510
South Central Connecticut Planning Region (203) 688-2046
TAYLOR KINGSTON
Dietitian, Registered
20 YORK ST, FOOD AND NUTRITION EPB806
NEW HAVEN, CT 06510
South Central Connecticut Planning Region (203) 688-9185
DR. TRAVIS DANIEL BONTRAGER MD
Hospitalist
20 YORK ST
NEW HAVEN, CT 06510
South Central Connecticut Planning Region (203) 688-1734
NEEHARIKA THOTTEMPUDI MBBS
Psychiatry & Neurology (Neurology)
20 YORK ST
NEW HAVEN, CT 06510
South Central Connecticut Planning Region (203) 688-4242
TERESA JOSEPH D.O.
Internal Medicine (Nephrology)
20 YORK ST
NEW HAVEN, CT 06510
South Central Connecticut Planning Region (203) 737-8894
MR. BRAD ST. MARTIN MD
Obstetrics & Gynecology
20 YORK ST
NEW HAVEN, CT 06510
South Central Connecticut Planning Region (203) 688-4242

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 Rebecca Forman's NPI number?

The NPI number for Rebecca Forman is 1124683651. It was assigned to this individual provider in the NPPES registry on May 9, 2019. The provider is also known as Rebecca Bella Gross.

Where is Rebecca Forman located?

Rebecca Forman practices at 20 York St, New Haven, CT 06510. The listed phone number is (203) 688-4242.

What is Rebecca Forman's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Rebecca Forman enrolled in Medicare?

Yes. Rebecca Forman 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.

Is Rebecca Forman affiliated with any hospitals?

According to CMS data, Rebecca Forman is affiliated with Hospital Of Univ Of Pennsylvania, Penn Presbyterian Medical Center and Pennsylvania Hospital.

When was this NPI record last updated?

The NPPES record for Rebecca Forman was last updated on May 9, 2019. NPI Profile syncs with the weekly NPPES data releases published by CMS.