NPIMap

Individual provider Active NPI

Richard A St. Dennis, PA

  • Physician Assistant
  • Coventry, RI
National Provider Identifier
1306879242
Registry record updated Sep 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA00503 Issued in RI
Practice address
10 Woodland Dr
Coventry, RI 02816-6716
Phone
(401) 826-2000
NPI assigned
Jul 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 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 001203 CT
Physician Assistant 363A00000X PA00503 RI Primary

Addresses

Primary practice location

10 Woodland Dr
Coventry, RI 02816-6716

Mailing address

PO Box 62939
Baltimore, MD 21264-1551
Phone (859) 291-4800

Other identifiers 1

IdentifierTypeStateIssuer
RS77579MedicaidRI

Other names 1

  • Richard A St. Dennis Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091029000065 RI Practitioner - Physician Assistant 4486547098 Reassigns benefits to 4 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
001203CTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Medexpress Urgent Care Connecticut, P.C. CurrentSince May 4, 2019 Accepting new patients
Prospect CT Medical Foundation, Inc. Medical Past Accepting new patients
Jerrold N Rosenberg.MD Inc PastSince Apr 1, 1999 Accepting new patients
Aakaish Sanjeevi Home Health Physicians Past Accepting new patients
WRK Ventures, LLC Past Accepting new patients
Memorial Hospital Past Accepting new patients
Healthwise Medical Associates, LLP Past Accepting new patients
Johnson Memorial Hospital, Inc. Past Accepting new patients
Trinity Health of New England Provider Network Organization Inc Past Accepting new patients

Locations

68 Division St
Derby, CT 06418
Phone (203) 732-6802

Organizations & group practices 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695859200000",
    "number": "1306879242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 62939",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212641551",
            "telephone_number": "859-291-4800",
            "fax_number": "833-694-1507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 WOODLAND DR",
            "city": "COVENTRY",
            "state": "RI",
            "postal_code": "028166716",
            "telephone_number": "401-826-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ST. DENNIS",
        "first_name": "RICHARD",
        "middle_name": "A",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2023-09-28",
        "certification_date": "2023-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "001203",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "RI",
            "license": "PA00503",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RS77579",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RICHARD",
            "last_name": "ST. DENNIS",
            "middle_name": "A",
            "credential": "PA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Coventry, RI

Sources for this page

Verify at the official NPI Registry.