Physicians of Rhode Island Enterprises Incorporated

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

MD10232 Issued in RI

Legal business name

PHYSICIANS OF RHODE ISLAND ENTERPRISES INCORPORATED

Doing business as

Prime

Practice address

10 Nate Whipple HW 101
Cumberland, RI 02864

Phone

(401) 658-2020

Fax

(401) 658-3612

NPI assigned

Oct 24, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Direndia Shackelford

Title

Managed Care Specialist

Phone

(800) 654-0889

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• PRIME Doing business as

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1144304783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 NATE WHIPPLE HW 101",
            "city": "CUMBERLAND",
            "state": "RI",
            "postal_code": "02864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 NATE WHIPPLE HW 101",
            "city": "CUMBERLAND",
            "state": "RI",
            "postal_code": "02864",
            "telephone_number": "401-658-2020",
            "fax_number": "401-658-3612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIANS OF RHODE ISLAND ENTERPRISES INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SHACKELFORD",
        "authorized_official_first_name": "DIRENDIA",
        "authorized_official_title_or_position": "MANAGED CARE SPECIALIST",
        "authorized_official_telephone_number": "800-654-0889"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "RI",
            "license": "MD10232",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7008326",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "4106426",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PRIME",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stephanie M Peduto, M.D.
• Jessica L Peipock, LICSW
• Jennifer Lynn Perreault
• Sarah Nichole Perry, COTA/L
• Personal Home Health Services, Inc
• Physicians of Rhode Island Medical Enterprises, Inc.
• Junette Pierre
• Jessica Lynn Pinto, DPT
• Amy Polanco, LICSW
• Lyndsey Pomfret, DPT

• Non-Pharmacy Dispensing Site in Cumberland, RI
• Providers in Cumberland, RI by specialty
• Non-Pharmacy Dispensing Site in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.