NPIMap

Individual provider Active NPI

Kathy Ann Rebeiro, APRN-CNP

  • Adult Health Nurse Practitioner
  • Providence, RI
National Provider Identifier
1073539813
Registry record updated Feb 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
APRN01191 Issued in RI
Practice address
1195 North Main Street
Cnemg Primary Care WMC
Providence, RI 02904-0288
Phone
(401) 736-4562
Fax
(401) 921-9864
NPI assigned
Jul 14, 2006
Last updated
Feb 19, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X CNPP37182 RI
Adult Health Nurse Practitioner 363LA2200X APRN01191 RI Primary

Addresses

Primary practice location

1195 North Main Street
Cnemg Primary Care WMC
Providence, RI 02904-0288

Mailing address

455 Toll Gate Rd
PRC and Credentialing
Warwick, RI 02886-2759
Phone (401) 736-4562

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
I20051118000642 RI Practitioner - Nurse Practitioner 0143249144 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Affinity Physicians LLC.Group PAC ID 0244413391, 723 clinicians

Practice addresses (Care Compare)

101 Dudley St
Providence, RI 02905-2401
Phone (401) 274-1122

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
CNPP37182RIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Affinity Physicians LLC CurrentSince Feb 1, 2025 Accepting new patients
Coastal Medical Physicians, Inc. CurrentSince Apr 1, 2024 Accepting new patients
The Miriam Hospital CurrentSince Aug 1, 2011 Accepting new patients
Affinity Physicians LLC. CurrentSince Feb 1, 2025 Accepting new patients
Lifespan Physician Group, Inc. CurrentSince Mar 29, 2015 Accepting new patients
The Miriam Hospital CurrentSince Aug 1, 2011 Accepting new patients
Lifespan Physician Group, Inc. Nurse Practitioner CurrentSince Mar 29, 2015 Accepting new patients
The Miriam Hospital Current Accepting new patients
Coastal Medical Physicians, Inc. Nurse Practitioner CurrentSince Apr 1, 2024 Accepting new patients
The Miriam Hospital Current Accepting new patients
The Miriam Hospital Current Accepting new patients
Women & Infants Hospital of Rhode Island Past Accepting new patients

Locations

900 Warren Ave
Ste 401
East Providence, RI 02914
Phone (401) 330-2480

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

101 Dudley St
Providence, RI 02905
Phone (401) 453-7950

117 Ellenfield St
Ste 101
Providence, RI 02905
Phone (401) 444-4318

1195 N Main St
Providence, RI 02904
Phone (401) 654-4433

146 W River St
Providence, RI 02904
Phone (401) 606-3000

146 W River St
Fl 3
Providence, RI 02904
Phone (401) 793-5700

146 W River St
Ste 11C
Providence, RI 02904
Phone (401) 606-3000

455 Toll Gate Rd
Warwick, RI 02886
Phone (401) 737-7000

Interoperability endpoints

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

Organizations & group practices 12

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 8

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": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739923200000",
    "number": "1073539813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 TOLL GATE RD",
            "address_2": "PRC AND CREDENTIALING",
            "city": "WARWICK",
            "state": "RI",
            "postal_code": "028862759",
            "telephone_number": "401-736-4562",
            "fax_number": "401-921-9864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1195 NORTH MAIN STREET",
            "address_2": "CNEMG PRIMARY CARE WMC",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029040288",
            "telephone_number": "401-736-4562",
            "fax_number": "401-921-9864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REBEIRO",
        "first_name": "KATHY",
        "middle_name": "ANN",
        "credential": "APRN-CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-14",
        "last_updated": "2025-02-19",
        "certification_date": "2025-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "RI",
            "license": "CNPP37182",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "RI",
            "license": "APRN01191",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.