NPIMap

Individual provider Active NPI

Mary Reedy

  • Surgical Physician Assistant
  • Providence, RI
National Provider Identifier
1023647534
Registry record updated Feb 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA01295 Issued in RI
Practice address
17 University Ave
Providence, RI 02906-4121
Phone
(775) 250-6885
NPI assigned
Apr 6, 2020
Last updated
Feb 10, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 10, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Surgical Physician Assistant 363AS0400X PA01295 RI Primary

Addresses

Primary practice location

17 University Ave
Providence, RI 02906-4121

Mailing address

17 University Ave
Providence, RI 02906-4121

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210220000050 RI Practitioner - Physician Assistant 0244645406 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rhode Island HospitalGroup PAC ID 8921900044, 430 clinicians

Practice addresses (Care Compare)

2 Dudley St
Providence, RI 02905-3236
Phone (401) 444-5662

593 Eddy St
Providence, RI 02903-4923

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA01295RIMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopedics Rhode Island, Inc CurrentSince Jan 25, 2021 Accepting new patients
Rhode Island Hospital CurrentSince Apr 29, 2024 Accepting new patients
Lifespan Physician Group, Inc. CurrentSince Apr 29, 2024 Accepting new patients
Lifespan Physician Group, Inc. CurrentSince Apr 29, 2024 Accepting new patients
Lifespan Corporation Current Accepting new patients
Orthopedics Rhode Island, Inc CurrentSince Jan 25, 2021 Accepting new patients
Rhode Island Hospital CurrentSince Apr 29, 2024 Accepting new patients
Orthopedics Rhode Island, Inc Past Accepting new patients
Rhode Island Hospital Past Accepting new patients

Locations

1454 S County Trl
Ste 2100
East Greenwich, RI 02818
Phone (401) 606-2000

185A High Service Ave
North Providence, RI 02904
Phone (401) 354-6050

588 Pawtucket Ave
Pawtucket, RI 02860
Phone (401) 722-2400

593 Eddy St
Providence, RI 02903

593 Eddy St
Ste 9B
Providence, RI 02903
Phone (401) 444-5280

200 Crossings Blvd
Ste 310
Warwick, RI 02886

300 Crossings Blvd
Warwick, RI 02886
Phone (716) 208-1708

Interoperability endpoints

  • Direct secure messaging: mreedy189151@brownhealth.medalliesdirect.net

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1586131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612915200000",
    "number": "1023647534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 UNIVERSITY AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029064121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 UNIVERSITY AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029064121",
            "telephone_number": "775-250-6885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REEDY",
        "first_name": "MARY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-06",
        "last_updated": "2021-02-10",
        "certification_date": "2021-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "RI",
            "license": "PA01295",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.