NPIMap

Organization Active NPI

Landmark Medical Center

Doing business as Landmark MC Occupational Medicine Dept. NP

  • Nurse Practitioner
  • Woonsocket, RI
National Provider Identifier
1285611392
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
00117 Issued in RI
Legal business name
LANDMARK MEDICAL CENTER
Doing business as
Landmark MC Occupational Medicine Dept. NP
Practice address
115 Cass Ave
Woonsocket, RI 02895-4705
Phone
(401) 769-4100
Fax
(401) 769-1744
NPI assigned
Dec 29, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mary Macintosh
Title
SVP/Cfo
Phone
(401) 769-4100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363L00000X 00117 RI Primary

Addresses

Primary practice location

115 Cass Ave
Woonsocket, RI 02895-4705

Mailing address

196 Cass Ave
Woonsocket, RI 02895-4712
Phone (401) 769-4100

Other identifiers 1

IdentifierTypeStateIssuer
0000028083OtherRIBEACON/BLUE SHIELD (NP)

Other names 1

  • Landmark MC Occupational Medicine Dept. NP Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Landmark Comprehensive Psyc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1135814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1285611392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "196 CASS AVE",
            "city": "WOONSOCKET",
            "state": "RI",
            "postal_code": "028954712",
            "telephone_number": "401-769-4100",
            "fax_number": "401-765-6024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 CASS AVE",
            "city": "WOONSOCKET",
            "state": "RI",
            "postal_code": "028954705",
            "telephone_number": "401-769-4100",
            "fax_number": "401-769-1744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LANDMARK MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MACINTOSH",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "SVP/CFO",
        "authorized_official_telephone_number": "401-769-4100"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": "RI",
            "license": "00117",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BEACON/BLUE SHIELD (NP)",
            "identifier": "0000028083",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Landmark MC Occupational Medicine Dept. NP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Woonsocket, RI

Sources for this page

  • 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.