Individual provider Active NPI

Michael Coyne Kavanaugh, MD

  • Diagnostic Radiology Physician
  • Providence, RI
National Provider Identifier
1215468814
Registry record updated Apr 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
MD17199 Issued in RI
Practice address
593 Eddy St
Providence, RI 02903
Phone
(401) 444-4000
NPI assigned
Mar 24, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 5, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Diagnostic Radiology Physician 2085R0202X MD17199 RI Primary
Diagnostic Radiology Physician 2085R0202X 1013402 MA

Addresses

Primary practice location

593 Eddy St
Providence, RI 02903

Mailing address

125 Metro Center Blvd Ste 2000
Warwick, RI 02886-1785
Phone (401) 432-2500

Other practice location 1

211 Park St
Attleboro, MA 02703-3143
Phone (508) 222-5200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, RI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20240703001867 MA Practitioner - Diagnostic RadiologyPractitioner - Nuclear Medicine 7416298005 Reassigns benefits to 1 organization
I20240724000748 RI Practitioner - Diagnostic RadiologyPractitioner - Nuclear Medicine 7416298005 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic RadiologyAlso: Nuclear Medicine
Education
Tulane University School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rhode Island Medical Imaging IncGroup PAC ID 8022097815, shared by 2 NPIs, 107 clinicians

Practice addresses (Care Compare)

211 Park St
Attleboro, MA 02703-3143
Phone (508) 222-5200

593 Eddy St
Providence, RI 02903-4923
Phone (401) 444-4000

Hospital & facility affiliations

  • Kent County Memorial Hospital Hospital, Warwick, RI, CCN 410009
  • Rhode Island Hospital Hospital, Providence, RI, CCN 410007
  • Sturdy Memorial Hospital Hospital, Attleboro, MA, CCN 220008
  • The Miriam Hospital Hospital, Providence, RI, CCN 410012
  • South County Hospital Inc Hospital, Wakefield, RI, CCN 410008

Merit-based Incentive Payment System (MIPS)

Final score
86.17 of 100Reported as group
Quality
82.44
Improvement activities
40
Cost
86.08

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Rhode Island Medical Imaging Inc Diagnostic Radiology CurrentSince Jul 1, 2024 Accepting new patients
Rhode Island Medical Imaging Inc Diagnostic Radiology CurrentSince Jul 1, 2024 Accepting new patients

Locations

60 Messenger St
Plainville, MA 02762
Phone (508) 695-0055

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

164 Summit Ave
Providence, RI 02906
Phone (401) 793-2104

593 Eddy St
Providence, RI 02903

1 Randall Sq
Providence, RI 02904
Phone (401) 272-5500

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

Interoperability endpoints

  • Direct secure messaging: michael.kavanaugh.1@13700.direct.athenahealth.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.

Hospital & facility affiliations 9

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": "1490313600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712275200000",
    "number": "1215468814",
    "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": "401-432-2500",
            "fax_number": "401-889-3619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "593 EDDY ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "02903",
            "telephone_number": "401-444-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "211 Park St",
            "address_purpose": "LOCATION",
            "city": "Attleboro",
            "state": "MA",
            "postal_code": "027033143",
            "country_code": "US",
            "telephone_number": "508-222-5200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KAVANAUGH",
        "first_name": "MICHAEL",
        "middle_name": "COYNE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-03-24",
        "last_updated": "2024-04-05",
        "certification_date": "2024-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "RI",
            "license": "MD17199",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MA",
            "license": "1013402",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.