Individual provider Active NPI

Madison Wanyo, PA

  • Physician Assistant
  • Pawtucket, RI
National Provider Identifier
1245916592
Registry record updated Jul 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1145 Main St
Pawtucket, RI 02860-7825
Phone
(401) 722-0081
Fax
(401) 312-0318
NPI assigned
Jun 22, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2026

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 Primary
Family Medicine Physician 207Q00000X PA01619 RI

Addresses

Primary practice location

1145 Main St
Pawtucket, RI 02860-7825

Mailing address

1145 Main St
Pawtucket, RI 02860-7825
Phone (401) 722-0081

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
I20240503003298 RI Practitioner - Physician Assistant 7214377456 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Blackstone Valley Community Health Care IncGroup PAC ID 8628045762, 49 clinicians

Practice addresses (Care Compare)

39 E Ave
Pawtucket, RI 02860-4003
Phone (401) 312-9813

9 Chestnut St
Central Falls, RI 02863-2005
Phone (401) 722-0081

Hospital & facility affiliations

  • Women & Infants Hospital of Rhode Island Hospital, Providence, RI, CCN 410010

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Blackstone Valley Community Health Care, Inc. CurrentSince Mar 26, 2024 Accepting new patients

Locations

9 Chestnut St
Central Falls, RI 02863
Phone (401) 722-0081

39 East Ave
Pawtucket, RI 02860
Phone (401) 722-0081

Interoperability endpoints

  • Direct secure messaging: madison.lombari.p1@direct.bvchc.nextgenshare.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 1

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": "1687392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784073600000",
    "number": "1245916592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1145 MAIN ST",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028607825",
            "telephone_number": "401-722-0081",
            "fax_number": "401-312-0318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1145 MAIN ST",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028607825",
            "telephone_number": "401-722-0081",
            "fax_number": "401-312-0318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANYO",
        "first_name": "MADISON",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-22",
        "last_updated": "2026-07-15",
        "certification_date": "2026-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "RI",
            "license": "PA01619",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pawtucket, RI

Sources for this page

Verify at the official NPI Registry.