MICHAEL CONSTANTINE ANTONELLIS
NPI 1548930936
Physician Assistant in Bridgeport, CT

Active since September 16, 2021PECOS EnrolledAccepts Medicare Assignment
2800 MAIN STREET DEPT OF SURGERY, BRIDGEPORT, CT 06606(475) 210-6512 Get Directions Write a Review

NPPES record last updated: September 18, 2024. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Sep 18, 2024, Sep 16, 2021 (2 updates tracked since 2021).

About Michael Constantine Antonellis NPPES

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

MICHAEL CONSTANTINE ANTONELLIS (NPI 1548930936) is an individual physician assistant in Bridgeport, Connecticut, licensed in Connecticut (6627) and active in the NPI registry since September 2021. He is enrolled in Medicare PECOS, maintains a secondary practice location in Boston, and is a graduate of Other (2021).

NPPES Registry Identity

NPI1548930936
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameMICHAEL CONSTANTINE ANTONELLIS
Location Address2800 MAIN STREET DEPT OF SURGERYBridgeport, CT 06606
Mailing Address1290 Silas Deane HwyWethersfield, CT 06109-4337 · (203) 909-4171
Sole ProprietorNo
Medical School CMSOtherGraduated 2021
Enumeration DateSeptember 16, 2021
Last NPPES UpdateSeptember 18, 20242 updates tracked since enumeration
NPPES CertifiedSeptember 18, 2024
NPI 1548930936 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License Licensed in CT · 6627
Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

2800 MAIN STREET DEPT OF SURGERY, Bridgeport, CT 06606

Secondary Practice Location 1

Location 155 Fruit StBoston, MA 02114-2621 · Phone (617) 724-4100

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

Michael Constantine Antonellis 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 ID1052702867
PECOS Enrollment IDI20240926001299
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 06606 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
$75.55 typical visit price
range $19.76 – $149.26
Typical copayment $18.88 (range $4.94 – $37.31)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1548930936, enumerated as an "individual" on September 16, 2021.

The provider is located at 2800 MAIN STREET DEPT OF SURGERY BRIDGEPORT, CT 06606 and the phone number is (475) 210-6512.

Physician Assistant with taxonomy code 363A00000X.