NPIMap

Organization Active NPI

Prospect Chartercare RWMC, LLC

  • General Acute Care Hospital
  • Providence, RI
National Provider Identifier
1013332014
Registry record updated Jan 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
HOS00108 Issued in RI
Legal business name
PROSPECT CHARTERCARE RWMC, LLC
Practice address
825 Chalkstone Ave
Providence, RI 02908-4728
Phone
(401) 456-2000
Fax
(401) 456-2029
NPI assigned
Feb 27, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Robert Jon Elders
Title
Secretary
Phone
(714) 788-1249

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X HOS00108 RI Primary

Addresses

Primary practice location

825 Chalkstone Ave
Providence, RI 02908-4728

Mailing address

825 Chalkstone Ave
Providence, RI 02908-4728
Phone (401) 456-2000

Other identifiers 4

IdentifierTypeStateIssuer
4100004MedicaidRI
CA 2157OtherRIRAILROAD MEDICARE
OP00004MedicaidRI
999990000/12115 NOCDOtherRICHAMP VA

Other names 1

  • Roger Williams Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140404000099 RI Part A Provider - Hospital 0547492696 Practice locations: East Providence, RI; Johnston, RI; Providence, RI

Hospital certification: CCN 410004

Legal name
PROSPECT CHARTERCARE RWMC, LLC
Doing business as
ROGER WILLIAMS MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Sep 27, 2002
Beds
220
Ownership / control type
Private (for profit)
Most recent change of ownership
Jun 20, 2014 (2 total)
Organization structure
LLCProprietary
Incorporated
Aug 21, 2013 in RI
Enrollment address
825 Chalkstone Ave
Providence, RI 29084735
Main/Primary Hospital Location
Hospital subgroups
General, Acute care, Psychiatric, Psychiatric unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospital

Medicare Care Compare
Listed as
Roger Williams Medical CenterCCN 410004
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Proprietary
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

49 Old Pocasset Rd
Johnston, RI 02919
Phone (401) 529-3625

Ownership & related parties

All disclosed owners & managing parties 17

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Sang Bum Lee Individual 5% Or Greater Indirect Ownership Interest Jun 1, 2014 66.67%
Corporate OfficerSVP Nov 13, 2014
Corporate DirectorDirector Jun 1, 2014
Jeffrey H Liebman Individual Corporate OfficerCeo Oct 29, 2018
W-2 Managing Employee Oct 29, 2018
Robert Elders Individual Corporate OfficerSecretary Jun 15, 2020
Prospect East Holdings, Inc. Organization, Los Angeles, CA For-profit 5% Or Greater Indirect Ownership Interest Jun 1, 2014 85%
JP Morgan Chase, N.a. Organization, Columbus, OH Financial institution 5% Or Greater Security Interest Jun 30, 2016 100%
Eric Samuels Individual Corporate OfficerTreasurer Jun 3, 2019
Alfredo Sabillo Individual Corporate OfficerAssistant Treasurer Jul 21, 2020
Ivy Holdings Inc Organization, Los Angeles, CA For-profit 5% Or Greater Indirect Ownership Interest Jun 1, 2014 85%
Chartercare Community Board Organization, Providence, RI Non-profit 5% Or Greater Indirect Ownership Interest Jun 1, 2014 15%
William M Gorenstein Individual Corporate OfficerSVP Aug 15, 2016
David & Alexa Topper Family Trust Organization, Beverly Hills, CA 5% Or Greater Indirect Ownership Interest Jun 1, 2014 33.33%
Ivy Intermediate Holding, Inc. Organization, Los Angeles, CA For-profit 5% Or Greater Indirect Ownership Interest Jun 1, 2014 85%
Prospect Chartercare, LLC Organization, Los Angeles, CA For-profit 5% Or Greater Direct Ownership Interest Jun 1, 2014 100%
David R Topper Individual Corporate OfficerSVP Nov 13, 2014
Corporate DirectorDirector Jun 1, 2014
Other Jun 1, 2014
Lynn a Leahey Individual Corporate OfficerCno Feb 1, 2019
Chamber Inc Organization, Los Angeles, CA Corporation 5% Or Greater Indirect Ownership Interest Jun 1, 2021 100%
Prospect Medical Holdings Inc Organization, Los Angeles, CA For-profit 5% Or Greater Indirect Ownership Interest Jun 1, 2014 85%

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Chartercare Home Health ServicesProvidence, RI, CCN 417029 Home health agency 5% Or Greater Indirect Ownership Interest (100%) Nov 16, 2017

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 12

Facilities that share an organizational owner with 5% or greater ownership or operational control.

  • Prospect Chartercare Home Health and Hospice, LLC
    • Home Health Agency
    • Providence, RI
    • NPI 1811402100

    Chamber Inc, David & Alexa Topper Family Trust, Ivy Holdings Inc, Prospect Chartercare, LLC, Prospect East Holdings, Inc., Prospect Medical Holdings Inc

    CMS ownership
  • Prospect Chartercare RWMC, LLC
    • Psychiatric Hospital Unit
    • Providence, RI
    • NPI 1477978476

    Chamber Inc, Chartercare Community Board, David & Alexa Topper Family Trust, Ivy Holdings Inc, Ivy Intermediate Holding, Inc., Prospect Chartercare, LLC, Prospect East Holdings, Inc., Prospect Medical Holdings Inc

    CMS ownership
  • Prospect Chartercare Sjhsri, LLC
    • Rehabilitation Hospital Unit
    • North Providence, RI
    • NPI 1205251204

    Chamber Inc, David & Alexa Topper Family Trust, Ivy Holdings Inc, Ivy Intermediate Holding, Inc., Prospect Chartercare, LLC, Prospect East Holdings, Inc., Prospect Medical Holdings Inc

    CMS ownership
  • Prospect Chartercare Sjhsri, LLC
    • Psychiatric Hospital Unit
    • North Providence, RI
    • NPI 1396160396

    Chamber Inc, David & Alexa Topper Family Trust, Ivy Holdings Inc, Ivy Intermediate Holding, Inc., Prospect Chartercare, LLC, Prospect East Holdings, Inc., Prospect Medical Holdings Inc

    CMS ownership
  • Prospect Chartercare Sjhsri, LLC
    • General Acute Care Hospital
    • North Providence, RI
    • NPI 1871918870

    Chamber Inc, David & Alexa Topper Family Trust, Ivy Holdings Inc, Ivy Intermediate Holding, Inc., Prospect Chartercare, LLC, Prospect East Holdings, Inc., Prospect Medical Holdings Inc

    CMS ownership
  • Alta Los Angeles Hospitals, Inc.
    • General Acute Care Hospital
    • Los Angeles, CA
    • NPI 1922001809

    Chamber Inc, David & Alexa Topper Family Trust, Ivy Holdings Inc, Prospect Medical Holdings Inc

    CMS ownership
  • Alta Newport Hospital, LLC
    • Pediatric Skilled Nursing Facility
    • Tustin, CA
    • NPI 1689096406

    Chamber Inc, David & Alexa Topper Family Trust, Ivy Holdings Inc, Prospect Medical Holdings Inc

    CMS ownership
  • Prospect Waterbury Home Health, Inc.
    • Home Health Agency
    • Watertown, CT
    • NPI 1265880413

    Chamber Inc, David & Alexa Topper Family Trust, Ivy Holdings Inc, Prospect Medical Holdings Inc

    CMS ownership
  • Prospect Waterbury, Inc.
    • General Acute Care Hospital
    • Waterbury, CT
    • NPI 1477902641

    Chamber Inc, David & Alexa Topper Family Trust, Ivy Holdings Inc, Prospect Medical Holdings Inc

    CMS ownership
  • Southern California Healthcare System, Inc
    • General Acute Care Hospital
    • Hollywood, CA
    • NPI 1023010113

    Chamber Inc, David & Alexa Topper Family Trust, Ivy Holdings Inc, Prospect Medical Holdings Inc

    CMS ownership
  • Southern California Healthcare System, Inc
    • Rehabilitation Hospital Unit
    • Culver City, CA
    • NPI 1861744138

    Chamber Inc, David & Alexa Topper Family Trust, Ivy Holdings Inc, Prospect Medical Holdings Inc

    CMS ownership
  • Southern California Healthcare System, Inc
    • Skilled Nursing Facility
    • Culver City, CA
    • NPI 1922350206

    Chamber Inc, David & Alexa Topper Family Trust, Ivy Holdings Inc, Prospect Medical Holdings Inc

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 66

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 66

Affiliated clinicians 235

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 235

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1393459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610323200000",
    "number": "1013332014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 CHALKSTONE AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029084728",
            "telephone_number": "401-456-2000",
            "fax_number": "401-456-2029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 CHALKSTONE AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029084728",
            "telephone_number": "401-456-2000",
            "fax_number": "401-456-2029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROSPECT CHARTERCARE RWMC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-27",
        "last_updated": "2021-01-11",
        "certification_date": "2021-01-11",
        "status": "A",
        "authorized_official_last_name": "ELDERS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "JON",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "714-788-1249"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "RI",
            "license": "HOS00108",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4100004",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CA 2157",
            "state": "RI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OP00004",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMP VA",
            "identifier": "999990000/12115 NOCD",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Roger Williams Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Roger Williams Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.