NPIMap

Individual provider Active NPI

Kely Cristina Jeronimo, P.A

  • Physician Assistant
  • Providence, RI
National Provider Identifier
1184930836
Registry record updated Sep 11, 2020
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Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA549 Issued in RI
Practice address
164 Summit Ave
Dept of Surgery
Providence, RI 02906-3418
Phone
(774) 287-4181
NPI assigned
Aug 19, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA7655 MA
Physician Assistant 363A00000X PA549 RI Primary

Addresses

Primary practice location

164 Summit Ave
Dept of Surgery
Providence, RI 02906-3418

Mailing address

125 Metro Center Blvd Ste 2000
Warwick, RI 02886-1785
Phone (401) 432-2520

Other practice location 1

125 Metro Center Blvd Ste 2000
Warwick, RI 02886-1785
Phone (401) 432-2520

Other practice location 2

211 Park St
Attleboro, MA 02703-3137
Phone (508) 222-5200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI, MA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110518000263 RI Practitioner - Physician Assistant 4587840087 Reassigns benefits to 1 organization
I20201023002294 MA Practitioner - Physician Assistant 4587840087 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rhode Island Medical Imaging IncGroup PAC ID 8022097815, 107 clinicians

Practice addresses (Care Compare)

1 Kettle Point Ave
East Providence, RI 02914-5375
Phone (401) 626-3900

200 High Service Ave
North Providence, RI 02904-5113
Phone (401) 456-3000

Hospital & facility affiliations

  • Newport Hospital Hospital, Newport, RI, CCN 410006
  • The Miriam Hospital Hospital, Providence, RI, CCN 410012
  • Rhode Island Hospital Hospital, Providence, RI, CCN 410007
  • Roger Williams Medical Center Hospital, Providence, RI, CCN 410004

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA7655MAMDPhysician Assistant
PA549RIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Rhode Island Medical Imaging Inc PastSince Jun 26, 2022 Accepting new patients
Memorial Hospital Past Accepting new patients

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 and National Provider Directory roles.

Hospital & facility affiliations 7

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": "1282176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599782400000",
    "number": "1184930836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 METRO CENTER BLVD STE 2000",
            "city": "WARWICK",
            "state": "RI",
            "postal_code": "028861785",
            "telephone_number": "401-432-2520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "164 SUMMIT AVE",
            "address_2": "DEPT OF SURGERY",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029063418",
            "telephone_number": "774-287-4181"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "125 Metro Center Blvd Ste 2000",
            "address_purpose": "LOCATION",
            "city": "Warwick",
            "state": "RI",
            "postal_code": "028861785",
            "country_code": "US",
            "telephone_number": "401-432-2520",
            "fax_number": "401-921-9212",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "211 Park St",
            "address_purpose": "LOCATION",
            "city": "Attleboro",
            "state": "MA",
            "postal_code": "027033137",
            "country_code": "US",
            "telephone_number": "508-222-5200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JERONIMO",
        "first_name": "KELY",
        "middle_name": "CRISTINA",
        "name_prefix": "Mrs.",
        "credential": "P.A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-19",
        "last_updated": "2020-09-11",
        "certification_date": "2020-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA7655",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "RI",
            "license": "PA549",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.