Individual provider Active NPI

Lynne A Bisbano, PA-C

  • Physician Assistant
  • Providence, RI
National Provider Identifier
1245234517
Registry record updated Oct 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA00080 Issued in RI
Practice address
345 Blackstone Blvd
Providence, RI 02906-4800
Phone
(401) 455-6200
Fax
(401) 455-6689
NPI assigned
Jun 2, 2005
Last updated
Oct 24, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA00080 RI Primary
Physician Assistant 363A00000X PA245 MA

Addresses

Primary practice location

345 Blackstone Blvd
Providence, RI 02906-4800

Mailing address

345 Blackstone Blvd
Providence, RI 02906-4829
Phone (401) 455-6200

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150729008817 RI Practitioner - Physician Assistant 6305944877 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Affinity Physicians LLC.Group PAC ID 0244413391, 723 clinicians

Practice addresses (Care Compare)

455 Toll Gate Rd
Warwick, RI 02886-2759
Phone (401) 737-7010

455 Tollgate Rd
Warwick, RI 02886-2759

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Bachelor of Science, Physician Assistant

State licenses

LicenseStateTypeSpecialty
245MAMDMarriage & Family Therapist
PA245MAMDPhysician Assistant
PA00080RIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Rhode Island Hospital CurrentSince Apr 1, 2023 Accepting new patients
Affinity Physicians LLC. CurrentSince Dec 31, 2023 Accepting new patients
Rhode Island Hospital CurrentSince Apr 1, 2023 Accepting new patients
Coastal Medical, Inc. Past Accepting new patients
MW Wellness Ventures IV LLC Past Accepting new patients
Southcoast Physicians Group, Inc. Past Accepting new patients
Coastal Medical Inc Past Accepting new patients

Locations

1454 S County Trl
Ste 2100
East Greenwich, RI 02818
Phone (401) 606-2000

345 Blackstone Blvd
Providence, RI 02906
Phone (401) 455-6375

593 Eddy St
Providence, RI 02903

593 Eddy St
Ste 9B
Providence, RI 02903
Phone (401) 444-5280

455 Toll Gate Rd
Warwick, RI 02886
Phone (401) 737-7000

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1117670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698105600000",
    "number": "1245234517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 BLACKSTONE BLVD",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029064829",
            "telephone_number": "401-455-6200",
            "fax_number": "401-455-6689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 BLACKSTONE BLVD",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029064800",
            "telephone_number": "401-455-6200",
            "fax_number": "401-455-6689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BISBANO",
        "first_name": "LYNNE",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-02",
        "last_updated": "2023-10-24",
        "certification_date": "2023-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "RI",
            "license": "PA00080",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA245",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.