NPIMap

Individual provider Active NPI

Alicja Kreczko, MD

  • Obstetrics & Gynecology Physician
  • Providence, RI
National Provider Identifier
1124314695
Registry record updated Mar 31, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
MD15151 Issued in RI
Practice address
297 Promenade St
Providence, RI 02908-5720
Phone
(401) 490-6464
Fax
(401) 490-6470
NPI assigned
Jun 23, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X MD15151 RI Primary

Addresses

Primary practice location

297 Promenade St
Providence, RI 02908-5720

Mailing address

297 Promenade St
Providence, RI 02908-5720
Phone (401) 490-6464

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address alicja.kreczko.1@3516.direct.athenahealth.com

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
I20151210001236 RI Practitioner - Obstetrics/Gynecology 2668773979 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern New England Healthcare for Women, LLCGroup PAC ID 0042486649, 26 clinicians

Practice addresses (Care Compare)

297 Promenade St
Providence, RI 02908-5720
Phone (401) 490-6464

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD15151RIMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Affinity Physicians LLC CurrentSince Oct 1, 2016 Accepting new patients
Affinity Physicians LLC. Obstetrics & Gynecology CurrentSince Oct 1, 2016 Accepting new patients
Southern New England Healthcare for Women, LLC Obstetrics & Gynecology CurrentSince Mar 15, 2021 Accepting new patients

Locations

333 School St
Ste 205
Pawtucket, RI 02860
Phone (401) 724-0600

345 Blackstone Blvd
Providence, RI 02906
Phone (401) 455-6375

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

297 Promenade St
Providence, RI 02908
Phone (401) 490-6464

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

166 Toll Gate Rd
Warwick, RI 02886
Phone (401) 739-2000

Interoperability endpoints

  • Direct secure messaging: alicja.kreczko.1@3516.direct.athenahealth.com

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 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": "1308787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617148800000",
    "number": "1124314695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "297 PROMENADE ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029085720",
            "telephone_number": "401-490-6464",
            "fax_number": "401-490-6470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "297 PROMENADE ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029085720",
            "telephone_number": "401-490-6464",
            "fax_number": "401-490-6470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRECZKO",
        "first_name": "ALICJA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-23",
        "last_updated": "2021-03-31",
        "certification_date": "2021-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "RI",
            "license": "MD15151",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "alicja.kreczko.1@3516.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "Athena Direct Message",
            "address_1": "297 Promenade St",
            "city": "Providence",
            "state": "RI",
            "country_code": "US",
            "postal_code": "029085720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.