NPIMap

Individual provider Active NPI

Prerna Ganjoo, MD

  • Nephrology Physician
  • East Providence, RI
National Provider Identifier
1083843155
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
MD14641 Issued in RI
Practice address
318 Waterman Ave
East Providence, RI 02914-3525
Phone
(401) 438-5950
Fax
(401) 435-6700
NPI assigned
Jul 9, 2009
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD14641 RI
Nephrology Physician 207RN0300X MD14641 RI Primary

Addresses

Primary practice location

318 Waterman Ave
East Providence, RI 02914-3525

Mailing address

318 Waterman Ave
East Providcence, RI 02914
Phone (401) 438-5950

Other practice location 1

593 Eddy St
Providence, RI 02903-4923
Phone (401) 444-3985

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI, MA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140806001107 RI Practitioner - NephrologyPractitioner - Internal Medicine 2264659838 Reassigns benefits to 1 organization
I20170718003174 MA Practitioner - Nephrology 2264659838 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nephrology Associates IncGroup PAC ID 8426061185, 9 clinicians

Practice addresses (Care Compare)

211 Park St
Attleboro, MA 02703-3143
Phone (401) 438-5950

314 Taunton Ave
East Providence, RI 02914-2641
Phone (401) 438-5950

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD14641RIMDInternal Medicine Physician

Interoperability endpoints

  • Direct secure messaging: prerna.ganjoo.1@25334.direct.athenahealth.com

Organizations & group practices 1

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 11

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": "1247097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1083843155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "318 WATERMAN AVE",
            "city": "EAST PROVIDCENCE",
            "state": "RI",
            "postal_code": "02914",
            "telephone_number": "401-438-5950",
            "fax_number": "401-435-6700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "318 WATERMAN AVE",
            "city": "EAST PROVIDENCE",
            "state": "RI",
            "postal_code": "029143525",
            "telephone_number": "401-438-5950",
            "fax_number": "401-435-6700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "593 Eddy St",
            "address_purpose": "LOCATION",
            "city": "Providence",
            "state": "RI",
            "postal_code": "029034923",
            "country_code": "US",
            "telephone_number": "401-444-3985",
            "fax_number": "401-444-3986",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GANJOO",
        "first_name": "PRERNA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-09",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "RI",
            "license": "MD14641",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "RI",
            "license": "MD14641",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Providence, RI

Sources for this page

Verify at the official NPI Registry.