NPIMap

Individual provider Active NPI

Christopher J Superczynski, M.D.

  • Internal Medicine Physician
  • Lincoln, RI
National Provider Identifier
1184621138
Registry record updated Jun 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD10232 Issued in RI
Practice address
652 George Washington Hwy Unit 201
Lincoln, RI 02865-4267
Phone
(401) 353-5224
Fax
(401) 353-5162
NPI assigned
Jul 6, 2005
Last updated
Jun 25, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 25, 2021

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 MD1032 RI
Internal Medicine Physician 207R00000X MD10232 RI Primary

Addresses

Primary practice location

652 George Washington Hwy Unit 201
Lincoln, RI 02865-4267

Mailing address

652 George Washington Hwy Unit 201
Lincoln, RI 02865-4267
Phone (401) 353-5224

Other identifiers 1

IdentifierTypeStateIssuer
7008326MedicaidRI

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
I20070706000285 RI Practitioner - Internal MedicinePractitioner - Family Practice 7315844784 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Family Practice
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mdri LLCGroup PAC ID 6406291632, 17 clinicians

Practice addresses (Care Compare)

6 Blackstone Valley PL
Lincoln, RI 02865-1179
Phone (401) 638-6374

652 George Washington Hwy
Suite 201
Lincoln, RI 02865-4330
Phone (401) 353-5224

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD1032RIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Comprehensive Healthcare Inc. Internal Medicine CurrentSince Sep 1, 2006 Accepting new patients
Trumed Incorporated Internal Medicine PastSince Apr 30, 2003 Accepting new patients
Mineral Spring Primary Care Associates, LLC Internal Medicine PastSince Sep 1, 2014 Accepting new patients

Locations

652 George Washington Hwy
Unit 201
Lincoln, RI 02865
Phone (401) 353-5224

25 John a Cummings Way
Woonsocket, RI 02895
Phone (401) 235-7310

25 John a Cummings Way
Ste 3
Woonsocket, RI 02895
Phone (401) 766-2700

68 Cumberland St
Ste 304
Woonsocket, RI 02895
Phone (401) 235-1330

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/GACDAA/Endpoint/GACDAA

Organizations & group practices 4

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 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1120608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624579200000",
    "number": "1184621138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "652 GEORGE WASHINGTON HWY UNIT 201",
            "city": "LINCOLN",
            "state": "RI",
            "postal_code": "028654267",
            "telephone_number": "401-353-5224",
            "fax_number": "401-353-5162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "652 GEORGE WASHINGTON HWY UNIT 201",
            "city": "LINCOLN",
            "state": "RI",
            "postal_code": "028654267",
            "telephone_number": "401-353-5224",
            "fax_number": "401-353-5162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUPERCZYNSKI",
        "first_name": "CHRISTOPHER",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-06",
        "last_updated": "2021-06-25",
        "certification_date": "2021-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "RI",
            "license": "MD1032",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "RI",
            "license": "MD10232",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7008326",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lincoln, RI

Sources for this page

Verify at the official NPI Registry.