NPIMap

Organization Active NPI

Codac Inc

Doing business as Codac Newport

  • Methadone Clinic
  • Newport, RI
National Provider Identifier
1043436785
Registry record updated Dec 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
License
605.04 Issued in RI
Legal business name
CODAC INC
Doing business as
Codac Newport
Practice address
93 Thames St
Codac Newport
Newport, RI 02840
Phone
(401) 846-4150
Fax
(401) 846-9340
NPI assigned
Apr 18, 2007
Last updated
Dec 21, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2021

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

Authorized official

Name
Ms. Alisha M Bourdeau, BS
Title
Cfo
Phone
(401) 275-5038

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X 605.4 RI
Methadone Clinic 261QM2800X 605.4 RI
Methadone Clinic 261QM2800X 605.04 RI Primary
Primary Care Clinic/Center 261QP2300X ACF01632-05 RI
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 605.4 RI
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 605.04 RI
Substance Use Disorder Rehabilitation Hospital Unit 276400000X 605.4 RI
Addiction Medicine (Family Medicine) Physician 207QA0401X ACF01632-05 RI
Peer Specialist 175T00000X NU

Addresses

Primary practice location

93 Thames St
Codac Newport
Newport, RI 02840

Mailing address

1052 Park Ave
Cranston, RI 02910
Phone (401) 275-5038

Other names 1

  • Codac Newport Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
Opioid treatment program
Medicare-enrolled since Mar 1, 2020

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200618002698 RI Part B Supplier - Opioid Treatment Program (Otp) 4183046212 7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Warwick, RI; Saunderstown, RI; Providence, RI; Newport, RI; Cranston, RI; East Providence, RI

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Codac Inc10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640044800000",
    "number": "1043436785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1052 PARK AVE",
            "city": "CRANSTON",
            "state": "RI",
            "postal_code": "02910",
            "telephone_number": "401-275-5038",
            "fax_number": "401-942-3590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "93 THAMES ST",
            "address_2": "CODAC NEWPORT",
            "city": "NEWPORT",
            "state": "RI",
            "postal_code": "02840",
            "telephone_number": "401-846-4150",
            "fax_number": "401-846-9340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CODAC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-18",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-21",
        "status": "A",
        "authorized_official_last_name": "BOURDEAU",
        "authorized_official_first_name": "ALISHA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "401-275-5038",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "BS"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": "RI",
            "license": "605.4",
            "primary": false
        },
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "RI",
            "license": "605.4",
            "primary": false
        },
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": "RI",
            "license": "605.04",
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "RI",
            "license": "ACF01632-05",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "RI",
            "license": "605.4",
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "RI",
            "license": "605.04",
            "primary": false
        },
        {
            "code": "276400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation, Substance Use Disorder Unit",
            "state": "RI",
            "license": "605.4",
            "primary": false
        },
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "RI",
            "license": "ACF01632-05",
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Codac Newport",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Codac Newport",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newport, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.