Brian R Theroux, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA00289 Issued in RI

Practice address

1672 S County TRL
Ste 101
E Greenwich, RI 02818-5098

Phone

(401) 885-7546

Fax

(401) 885-6658

NPI assigned

Aug 14, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dermatology Professionals LLCGroup PAC ID 1254653355, 9 clinicians

Dermatology Professionals IncGroup PAC ID 9234283953, 19 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• The Miriam Hospital Hospital, Providence, RI, CCN 410012

Merit-based Incentive Payment System (MIPS)

Final score

92.67 of 100Reported as individual

Quality

86.67

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Interoperability endpoints

• Direct secure messaging: btheroux@apderm.emadirect.md

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.

• Dermatology Professionals Inc.

  • Dermatology Physician
  • East Greenwich, RI
  • NPI 1902040835
  Medicare reassignment Care Compare group
• Dermatology Professionals, LLC

  • Dermatology Physician
  • North Attleboro, MA
  • NPI 1992123525
  Medicare reassignment Care Compare group
• Coastal Dermatology Inc

  • Dermatology Physician
  • Westport, MA
  • NPI 1760927610
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• The Miriam Hospital

  • General Acute Care Hospital
  • Providence, RI
  • NPI 1487649430
  Care Compare affiliation

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340755200000",
    "number": "1275546277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1672 S COUNTY TRL",
            "address_2": "STE. 301",
            "city": "E GREENWICH",
            "state": "RI",
            "postal_code": "028185098",
            "telephone_number": "401-885-7546",
            "fax_number": "401-885-5465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1672 S COUNTY TRL",
            "address_2": "STE 101",
            "city": "E GREENWICH",
            "state": "RI",
            "postal_code": "028185098",
            "telephone_number": "401-885-7546",
            "fax_number": "401-885-6658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEROUX",
        "first_name": "BRIAN",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-14",
        "last_updated": "2012-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "RI",
            "license": "PA00289",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DE76182",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melissa B Ramocki, M.D., PH. D.
• Richard M Delsesto MD Ms LTD
• Elizabeth Rocchio
• Bruce L. Stevens, M.D.
• Fannie L. Tam, LICSW

• Medical Physician Assistant in E Greenwich, RI
• Providers in E Greenwich, RI by specialty
• Medical Physician Assistant in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.