NPIMap

Individual provider Active NPI

Mark Rosenberg, M.D.

  • Family Medicine Physician
  • Cranston, RI
National Provider Identifier
1053412767
Registry record updated Apr 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD09624 Issued in RI
Practice address
725 Reservoir Ave
Suite 102
Cranston, RI 02910-4448
Phone
(401) 943-6910
Fax
(401) 946-5130
NPI assigned
Sep 26, 2006
Last updated
Apr 11, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 11, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD09624 RI Primary

Addresses

Primary practice location

725 Reservoir Ave
Suite 102
Cranston, RI 02910-4448

Mailing address

725 Reservoir Ave
Suite 102
Cranston, RI 02910-4448
Phone (401) 943-6910

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
I20101027000167 RI Practitioner - Family Practice 9537053731 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Family Health and Sports Medicine LLCGroup PAC ID 4789809591, 4 clinicians

Practice addresses (Care Compare)

65 Sockanosset Cross Rd
Suite 301
Cranston, RI 02920-5536
Phone (401) 943-6910

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD09624RIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prime Healthcare Services Landmark LLC CurrentSince May 14, 2023 Accepting new patients
Prime Healthcare Services Landmark LLC CurrentSince Oct 26, 2020 Accepting new patients
Prime Healthcare Services Landmark LLC CurrentSince Oct 26, 2020 Accepting new patients

Locations

116 Eddie Dowling Hwy
North Smithfield, RI 02896
Phone (401) 766-0800

115 Cass Ave
Woonsocket, RI 02895
Phone (401) 356-1701

Interoperability endpoints

  • Direct secure messaging: mrosenberg@direct.carene.org

Organizations & group practices 4

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 10

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": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460332800000",
    "number": "1053412767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 RESERVOIR AVE",
            "address_2": "SUITE 102",
            "city": "CRANSTON",
            "state": "RI",
            "postal_code": "029104448",
            "telephone_number": "401-943-6910",
            "fax_number": "401-946-5130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 RESERVOIR AVE",
            "address_2": "SUITE 102",
            "city": "CRANSTON",
            "state": "RI",
            "postal_code": "029104448",
            "telephone_number": "401-943-6910",
            "fax_number": "401-946-5130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSENBERG",
        "first_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-26",
        "last_updated": "2016-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "RI",
            "license": "MD09624",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cranston, RI

Sources for this page

Verify at the official NPI Registry.