Individual provider Active NPI

Peter J Sardella, DPM

  • Foot & Ankle Surgery Podiatrist
  • Providence, RI
National Provider Identifier
1114019551
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
DPM00267 Issued in RI
Practice address
235 Plain Street
Suite 201
Providence, RI 02905-3240
Phone
(401) 861-8830
Fax
(401) 351-2378
NPI assigned
Sep 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X DPM00267 RI Primary

Addresses

Primary practice location

235 Plain Street
Suite 201
Providence, RI 02905-3240

Mailing address

235 Plain Street
Suite 201
Providence, RI 02905-3240
Phone (401) 861-8830

Other identifiers 1

IdentifierTypeStateIssuer
7002816MedicaidRI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080205000297 MA Practitioner - Podiatry 4284728593

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1964MAMDMental Health Counselor
DPM00267RIMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Peter J Sardella DPM LLC Foot & Ankle Surgery Current Accepting new patients

Locations

1591 Cranston St
Cranston, RI 02920
Phone (401) 946-9933

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1114019551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 PLAIN STREET",
            "address_2": "SUITE 201",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029053240",
            "telephone_number": "401-861-8830",
            "fax_number": "401-351-2378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 PLAIN STREET",
            "address_2": "SUITE 201",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029053240",
            "telephone_number": "401-861-8830",
            "fax_number": "401-351-2378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SARDELLA",
        "first_name": "PETER",
        "middle_name": "J",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "RI",
            "license": "DPM00267",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7002816",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.