Summit Medical Group

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

RI3593 Issued in RI

Legal business name

SUMMIT MEDICAL GROUP

Practice address

100 Highland Ave Ste 307
Providence, RI 02906-2753

Phone

(401) 331-5320

Fax

(401) 331-6168

NPI assigned

Jan 29, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Marvin Stuart Kerzner, MD

Title

Medical Director

Phone

(401) 331-5320

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1235275207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 HIGHLAND AVE STE 307",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029062753",
            "telephone_number": "401-331-5320",
            "fax_number": "401-331-6168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HIGHLAND AVE STE 307",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029062753",
            "telephone_number": "401-331-5320",
            "fax_number": "401-331-6168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KERZNER",
        "authorized_official_first_name": "MARVIN",
        "authorized_official_middle_name": "STUART",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "401-331-5320",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "RI",
            "license": "RI3593",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2059883",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "847-1",
            "state": "RI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000847",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shannon Sullivan, LCSW
• Tanya Christine Sullivan, APRN, MSN, CNP
• Vrishali Suman, MD
• Dale Sumilang
• Jack Rocco Summa, PHARMD, RPH
• Summit Ri SNF, LLC (Summit Commons Rehabilitation & Health Care Center)
• Felicia Wang Sun, MD, MPHIL
• Kevin Sun, MD
• Tianying Sun
• Nisha Sundararaj, LMHC

• Primary Care Clinic/Center in Providence, RI
• Providers in Providence, RI by specialty
• Primary Care Clinic/Center in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.