Individual provider Active NPI

Emily Ann Peterson, PA

  • Physician Assistant
  • Providence, RI
National Provider Identifier
1063203578
Registry record updated Jul 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA01810 Issued in RI
Practice address
593 Eddy St
Providence, RI 02903-4923
Phone
(401) 854-2505
NPI assigned
May 14, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA01810 RI Primary

Addresses

Primary practice location

593 Eddy St
Providence, RI 02903-4923

Mailing address

110 Elm St
Providence, RI 02903-4626

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250822002106 RI Practitioner - Physician Assistant 6608376751 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lifespan Physician Group IncGroup PAC ID 2567455082, 1,151 clinicians

Practice addresses (Care Compare)

593 Eddy St
Providence, RI 02903-4923
Phone (401) 444-7024

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lifespan Physician Group, Inc. Physician Assistant CurrentSince Feb 1, 2026 Accepting new patients
Lifespan Physician Group, Inc. CurrentSince Feb 1, 2026 Accepting new patients

Locations

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

164 Summit Ave
Providence, RI 02906
Phone (401) 793-2104

593 Eddy St
Providence, RI 02903

110 Elm St
Providence, RI 02903
Phone (401) 443-4992

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1747180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752710400000",
    "number": "1063203578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 ELM ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "593 EDDY ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034923",
            "telephone_number": "401-854-2505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "EMILY",
        "middle_name": "ANN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-05-14",
        "last_updated": "2025-07-17",
        "certification_date": "2025-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "RI",
            "license": "PA01810",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.