Individual provider Active NPI

Nadeem Anis, MD

  • Internal Medicine Physician
  • Providence, RI
National Provider Identifier
1275513442
Registry record updated Jan 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD13396 Issued in RI
Practice address
164 Summit Ave.
Providence, RI 02906
Phone
(401) 793-2104
Fax
(401) 793-4047
NPI assigned
Jan 22, 2006
Last updated
Jan 20, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2011

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X MD427665 PA
Internal Medicine Physician 207R00000X 234029 NY
Internal Medicine Physician 207R00000X MD13396 RI Primary
Internal Medicine Physician 207R00000X MD427665 PA

Addresses

Primary practice location

164 Summit Ave.
Providence, RI 02906

Mailing address

PO Box 3238
Boston, MA 02241
Phone (866) 689-8862

Other identifiers 1

IdentifierTypeStateIssuer
02621103MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI, MA2 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
I20110110000549 RI Practitioner - Internal Medicine 0446218507 Reassigns benefits to 1 organization
I20200403000199 MA Practitioner - Internal MedicinePractitioner - Hospitalist 0446218507 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lifespan Physician Group IncGroup PAC ID 2567455082, 1,151 clinicians

Practice addresses (Care Compare)

164 Summit Ave
Providence, RI 02906-2853

185 A High Service Ave
North Providence, RI 02904-5114
Phone (401) 354-6050

185 High Service Ave
North Providence, RI 02904-5114
Phone (401) 354-6050

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
234029NYMDInternal Medicine Physician
025558NYMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Steward Medical Group, Inc CurrentSince Apr 1, 2020 Accepting new patients
Lifespan Physician Group, Inc. CurrentSince Mar 29, 2015 Accepting new patients
Lifespan Physician Group, Inc. CurrentSince Mar 29, 2015 Accepting new patients
Steward Medical Group, Inc CurrentSince Apr 1, 2020 Accepting new patients
Lifespan Corporation Current Accepting new patients
North Shore Long Island Jewish Healthcare Internal Medicine Past Accepting new patients
Bioserenity DT Inc. Past Accepting new patients
Health Access Network Past Accepting new patients
University Health Physicians Internal Medicine Past Accepting new patients

Locations

11 Nevins St
Ste 201
Brighton, MA 02135
Phone (617) 789-2442

100 Amesbury St
Ste 103
Lawrence, MA 01840
Phone (978) 683-0157

9 Galen St
Watertown, MA 02472
Phone (617) 562-5413

185A High Service Ave
North Providence, RI 02904
Phone (401) 354-6050

79 Turnpike Ave
Portsmouth, RI 02871
Phone (401) 683-7434

117 Ellenfield St
Ste 101
Providence, RI 02905
Phone (401) 444-4318

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

Interoperability endpoints

  • Direct secure messaging: nanis15073@brownhealth.medalliesdirect.net

Organizations & group practices 9

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.

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": "1137888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295481600000",
    "number": "1275513442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3238",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "02241",
            "telephone_number": "866-689-8862",
            "fax_number": "207-347-7401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "164 SUMMIT AVE.",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "02906",
            "telephone_number": "401-793-2104",
            "fax_number": "401-793-4047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANIS",
        "first_name": "NADEEM",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-22",
        "last_updated": "2011-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "PA",
            "license": "MD427665",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "234029",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "RI",
            "license": "MD13396",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MD427665",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02621103",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.