NPIMap

Individual provider Active NPI

Katherine Maccallum, MD

  • Vascular Surgery Physician
  • Providence, RI
National Provider Identifier
1194110189
Registry record updated Sep 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
MD18473 Issued in RI
Practice address
2 Dudley St Ste 470
Providence, RI 02905-3248
Phone
(401) 553-8325
Fax
(401) 868-2336
NPI assigned
Apr 6, 2015
Last updated
Sep 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2022

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NY
Student in an Organized Health Care Education/Training Program 390200000X NU
Vascular Surgery Physician 2086S0129X 293441 MA
Vascular Surgery Physician 2086S0129X MD18473 RI Primary

Addresses

Primary practice location

2 Dudley St Ste 470
Providence, RI 02905-3248

Mailing address

2 Dudley St Ste 470
Providence, RI 02905-3248
Phone (401) 553-8325

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI, NY2 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
I20220728000808 RI Practitioner - Vascular Surgery 3870833692 Reassigns benefits to 2 organizations
I20260217001812 NY Practitioner - General SurgeryPractitioner - Vascular Surgery 3870833692 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lifespan Physician Group IncGroup PAC ID 2567455082, 1,151 clinicians
University Surgical Associates, Inc.Group PAC ID 4082503032, 105 clinicians

Practice addresses (Care Compare)

2 Dudley St
Suite 470
Providence, RI 02905-3248
Phone (401) 272-1800

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
293441MAMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Physician Affiliate Group of New York PC CurrentSince Dec 28, 2025 Accepting new patients
Rhode Island Hospital Current Accepting new patients
University Surgical Associates, Inc. CurrentSince Aug 29, 2022 Accepting new patients
Lifespan Physician Group, Inc. Vascular Surgery CurrentSince Dec 1, 2025 Accepting new patients
Lifespan Physician Group, Inc. CurrentSince Dec 1, 2025 Accepting new patients
Lifespan Physician Group, Inc. Past Accepting new patients
New York City Health and Hospitals Corporation Past Accepting new patients
Rhode Island Hospital Past Accepting new patients

Locations

2601 Ocean Pkwy
Brooklyn, NY 11235
Phone (718) 616-5354

506 Malcolm X Blvd
New York, NY 10037
Phone (212) 939-1000

185A High Service Ave
North Providence, RI 02904
Phone (401) 354-6050

2 Dudley St
Ste 470
Providence, RI 02905
Phone (401) 274-7546

900 Douglas Pike
Ste B1
Smithfield, RI 02917
Phone (401) 725-4888

Interoperability endpoints

  • Direct secure messaging: katherine.maccallum.usasurg@direct-address.net

Organizations & group practices 8

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 5

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": "1428278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663718400000",
    "number": "1194110189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 DUDLEY ST STE 470",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029053248",
            "telephone_number": "401-553-8325",
            "fax_number": "401-868-2336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 DUDLEY ST STE 470",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029053248",
            "telephone_number": "401-553-8325",
            "fax_number": "401-868-2336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MACCALLUM",
        "first_name": "KATHERINE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-06",
        "last_updated": "2022-09-21",
        "certification_date": "2022-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NY",
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "MA",
            "license": "293441",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "RI",
            "license": "MD18473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.