Individual provider Active NPI

Stephan P Pirnie, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Newport, RI
National Provider Identifier
1114459138
Registry record updated Jan 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
MD17534 Issued in RI
Practice address
11 Friendship St
Newport, RI 02840-2209
Phone
(401) 845-1190
Fax
(401) 845-1073
NPI assigned
Mar 29, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X MD17534 RI Primary

Addresses

Primary practice location

11 Friendship St
Newport, RI 02840-2209

Mailing address

117 Ellenfield St Ste 101
Providence, RI 02905-4541
Phone (401) 444-6779

Other practice location 1

55 Lake Ave N
Worcester, MA 01655-0002
Phone (508) 334-1000

Other identifiers 1

IdentifierTypeStateIssuer
1114459138MedicaidRI

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210823000873 RI Practitioner - Physical Medicine and Rehabilitation 2769756782 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
University of Connecticut School of Medicine, 2017
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)

11 Friendship St
Newport, RI 02840-2209
Phone (401) 845-1472

Hospital & facility affiliations

  • Newport Hospital Hospital, Newport, RI, CCN 410006

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lifespan Physician Group, Inc. CurrentSince Aug 1, 2021 Accepting new patients
Lifespan Physician Group, Inc. CurrentSince Aug 1, 2021 Accepting new patients
Lifespan Physician Group, Inc. Past Accepting new patients

Locations

11 Friendship St
Newport, RI 02840
Phone (401) 845-1110

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

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

593 Eddy St
Ste 7A
Providence, RI 02903
Phone (401) 444-8732

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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": "1490745600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736294400000",
    "number": "1114459138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 ELLENFIELD ST STE 101",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029054541",
            "telephone_number": "401-444-6779",
            "fax_number": "401-444-6912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 FRIENDSHIP ST",
            "city": "NEWPORT",
            "state": "RI",
            "postal_code": "028402209",
            "telephone_number": "401-845-1190",
            "fax_number": "401-845-1073"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "55 Lake Ave N",
            "address_purpose": "LOCATION",
            "city": "Worcester",
            "state": "MA",
            "postal_code": "016550002",
            "country_code": "US",
            "telephone_number": "508-334-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PIRNIE",
        "first_name": "STEPHAN",
        "middle_name": "P",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-29",
        "last_updated": "2025-01-08",
        "certification_date": "2025-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "RI",
            "license": "MD17534",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114459138",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newport, RI

Sources for this page

Verify at the official NPI Registry.