Active NPI
Henry Sisun, M.S.P.T.
- Physical Therapist
- Cranston, RI
National Provider Identifier
1235110073
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT00646
- Practice address
- 721 Reservoir Ave
Cranston, RI 02910-4430 - Phone
- (401) 946-4250
- Fax
- (401) 942-3960
- NPI assigned
- Nov 9, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT00646 | RI | Primary |
| Physical Therapist | 225100000X | 5669 | MA |
Addresses
Primary practice location
721 Reservoir Ave
Cranston, RI 02910-4430
Mailing address
721 Reservoir Ave
Cranston, RI 02910-4430
Phone (401) 946-4250
Other identifiers 13
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 70151140002 | Other | CIGNA NON-PAR | |
| 5712442 | Other | MA | AETNA INDIVIDUAL # |
| 1454-35-0001 | Other | RI | DMERC ID # |
| 401280 | Other | RI | RI BLUECHIP PROV # |
| 19016 | Other | NEIGHBORHOOD HEALTH PLAN | |
| AA46223 | Other | RI | HPHC RI PROV ID# |
| 605716 | Other | MA | HPHC MA PROV ID# |
| 7536 | Other | RI | RI BCBS PROV # |
| PT00646 | Other | RI | PT LICENSE # STATE OF RI |
| 2015585 | Other | RI | AETNA PROV ID# |
| PT0182 | Other | MA | MEDICARE GROUP # OT SERV |
| Y65737 | Other | MA | MA BCBS PROV ID # |
| 5669 | Other | MA | PT LICENSE STATE OF MA |
Other names 1
- Henry Sisun
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT00646 | RI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bay State Physical Therapy PC | Physical Therapist | Current | Accepting new patients |
Locations
721 Reservoir Ave
Cranston, RI 02910
Phone (401) 946-4250
2725 S County Trl
East Greenwich, RI 02818
Phone (401) 398-2525
Organizations & group practices 1
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.
-
- Physical Therapist
- Attleboro, MA
- NPI 1194387191
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131494400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317081600000",
"number": "1235110073",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "721 RESERVOIR AVE",
"city": "CRANSTON",
"state": "RI",
"postal_code": "029104430",
"telephone_number": "401-946-4250",
"fax_number": "401-942-3960"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "721 RESERVOIR AVE",
"city": "CRANSTON",
"state": "RI",
"postal_code": "029104430",
"telephone_number": "401-946-4250",
"fax_number": "401-942-3960"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SISUN",
"first_name": "HENRY",
"name_prefix": "Mr.",
"credential": "M.S.P.T.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-11-09",
"last_updated": "2011-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "RI",
"license": "PT00646",
"primary": true
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MA",
"license": "5669",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA NON-PAR",
"identifier": "70151140002",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA INDIVIDUAL #",
"identifier": "5712442",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DMERC ID #",
"identifier": "1454-35-0001",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RI BLUECHIP PROV #",
"identifier": "401280",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEIGHBORHOOD HEALTH PLAN",
"identifier": "19016",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HPHC RI PROV ID#",
"identifier": "AA46223",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HPHC MA PROV ID#",
"identifier": "605716",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RI BCBS PROV #",
"identifier": "7536",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PT LICENSE # STATE OF RI",
"identifier": "PT00646",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA PROV ID#",
"identifier": "2015585",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP # OT SERV",
"identifier": "PT0182",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MA BCBS PROV ID #",
"identifier": "Y65737",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PT LICENSE STATE OF MA",
"identifier": "5669",
"state": "MA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "HENRY",
"last_name": "SISUN",
"credential": "M.S.P.T.",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Cranston, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.