Individual provider Active NPI

Bridget M. Wieczkowski, MD

  • Pediatrics Physician
  • Providence, RI
National Provider Identifier
1194083386
Registry record updated Jul 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD17889 Issued in RI
Practice address
239 Cranston St
Providence, RI 02907-2406
Phone
(401) 444-0580
Fax
(401) 444-0428
NPI assigned
Apr 25, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 17125 NH
Pediatrics Physician 208000000X 285507 NY
Pediatrics Physician 208000000X MD17889 RI Primary

Addresses

Primary practice location

239 Cranston St
Providence, RI 02907-2406

Mailing address

375 Allens Ave
Providence, RI 02905-5010
Phone (401) 780-2511

Other names 1

  • Bridget M Oliveri Former name

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
I20210730000694 RI Practitioner - Pediatric Medicine 5799099453 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
The Providence Community Health Centers, Inc CurrentSince Jul 19, 2021 Accepting new patients
The Providence Community Health Centers Inc. Past Accepting new patients

Locations

239 Cranston St
Providence, RI 02907
Phone (401) 444-0580

375 Allens Ave
Providence, RI 02905
Phone (401) 444-0400

Interoperability endpoints

  • Direct secure messaging: bwieczkowski684318@nychhc.direct-ci.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1335312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625184000000",
    "number": "1194083386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 ALLENS AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029055010",
            "telephone_number": "401-780-2511",
            "fax_number": "401-780-2565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "239 CRANSTON ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029072406",
            "telephone_number": "401-444-0580",
            "fax_number": "401-444-0428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIECZKOWSKI",
        "first_name": "BRIDGET",
        "middle_name": "M.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-25",
        "last_updated": "2021-07-02",
        "certification_date": "2021-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NH",
            "license": "17125",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "285507",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "RI",
            "license": "MD17889",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRIDGET",
            "last_name": "OLIVERI",
            "middle_name": "M",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.