NPIMap

Organization Active NPI

Blackstone Medical Center, Inc.

  • Internal Medicine Physician
  • Woonsocket, RI
National Provider Identifier
1033464276
Registry record updated Jul 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
00117 Issued in RI
Legal business name
BLACKSTONE MEDICAL CENTER, INC.
Practice address
115 Cass Ave
Woonsocket, RI 02895-4705
Phone
(401) 769-4100
NPI assigned
Jul 13, 2012
Organization subpart
Yes
Parent organization
STEWARD MEDICAL HOLDINGS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 30, 2012

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

Authorized official

Name
Mr. James Renna
Title
Cfo
Phone
(617) 419-4772

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical NeuropsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103G00000X 00117 RI
Prescribing (Medical) PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TP0016X 00117 RI
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X 00117 RI Primary
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X 00117 RI
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X 00117 RI
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X 00117 RI

Addresses

Primary practice location

115 Cass Ave
Woonsocket, RI 02895-4705

Mailing address

219 Cass Avenue
Woonsocket, RI 02895-4741
Phone (401) 769-4100

Other names 1

  • Blackstone Medical Center Psych Other name

National Provider Directory

National Provider Directory
Tax ID family
Blackstone Medical Center Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1342137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1343606400000",
    "number": "1033464276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "219 CASS AVENUE",
            "city": "WOONSOCKET",
            "state": "RI",
            "postal_code": "028954741",
            "telephone_number": "401-769-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 CASS AVE",
            "city": "WOONSOCKET",
            "state": "RI",
            "postal_code": "028954705",
            "telephone_number": "401-769-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACKSTONE MEDICAL CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STEWARD MEDICAL HOLDINGS, LLC",
        "enumeration_date": "2012-07-13",
        "last_updated": "2012-07-30",
        "status": "A",
        "authorized_official_last_name": "RENNA",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "617-419-4772",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "RI",
            "license": "00117",
            "primary": false
        },
        {
            "code": "103TP0016X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": "RI",
            "license": "00117",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "RI",
            "license": "00117",
            "primary": true
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "RI",
            "license": "00117",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "RI",
            "license": "00117",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "RI",
            "license": "00117",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blackstone Medical Center Psych",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Woonsocket, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.