NPIMap

Organization Active NPI

Prospect Chartercare RWMC, LLC

Doing business as Roger Williams Medical Center

  • Cardiovascular Disease Physician
  • Providence, RI
National Provider Identifier
1326463548
Registry record updated Jan 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
PROSPECT CHARTERCARE RWMC, LLC
Doing business as
Roger Williams Medical Center
Practice address
825 Chalkstone Ave
Providence, RI 02908-4728
Phone
(401) 456-2000
Fax
(401) 456-2029
NPI assigned
Feb 25, 2014
Last updated
Jan 11, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2021

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

Authorized official

Name
Robert Jon Elders
Title
Secretary
Phone
(714) 788-1249

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
NutritionistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 133N00000X
Cardiovascular Disease PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RC0000X Primary

Addresses

Primary practice location

825 Chalkstone Ave
Providence, RI 02908-4728

Mailing address

825 Chalkstone Ave
Providence, RI 02908-4728
Phone (401) 456-2000

Other names 1

  • Roger Williams Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140728001672 RI Part B Supplier - Clinic/Group Practice 0547492696 Receives reassigned benefits from 182 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Warren, RI; E Providence, RI; Wakefield, RI; Providence, RI; North Providence, RI; Lincoln, RI; Johnston, RI; Greenville, RI…

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1 Office Pkwy
East Providence, RI 02914
Phone (401) 270-7110

425 Albion Rd
Lincoln, RI 02865
Phone (401) 333-1473

Interoperability endpoints

  • Direct secure messaging: andrea.demers@direct.chartercare.org
  • Direct secure messaging: anna.bunch@direct.chartercare.org
  • Direct secure messaging: diane.dubois_hall@direct.chartercare.org
  • Direct secure messaging: egrote@direct.chartercare.org
  • Direct secure messaging: jbonadona@direct.chartercare.org
  • Direct secure messaging: jeffrey.drogin@direct.chartercare.org
  • Direct secure messaging: jstoukid@direct.chartercare.org
  • Direct secure messaging: keya.malhotra@direct.chartercare.org
  • Direct secure messaging: kristine.mortel@direct.chartercare.org
  • Direct secure messaging: leanne.nadeau@direct.chartercare.org
  • Direct secure messaging: maria.soriano@direct.chartercare.org
  • Direct secure messaging: neenoofar.haneef@direct.chartercare.org
  • Direct secure messaging: peter.ameck@direct.chartercare.org
  • Direct secure messaging: psampath@direct.chartercare.org
  • Direct secure messaging: rafael.liporaci@direct.chartercare.org
  • Direct secure messaging: ralph.santoro@direct.chartercare.org
  • Direct secure messaging: rbrown@direct.chartercare.org
  • Direct secure messaging: riacobucci@direct.chartercare.org
  • Direct secure messaging: shahzad.khurshid@direct.chartercare.org
  • Direct secure messaging: vincent.perrelli@direct.chartercare.org

Practitioners & affiliated clinicians

Practitioners 173

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 173

NPI Registry JSON

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

{
    "created_epoch": "1393286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610323200000",
    "number": "1326463548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 CHALKSTONE AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029084728",
            "telephone_number": "401-456-2000",
            "fax_number": "401-456-2029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 CHALKSTONE AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029084728",
            "telephone_number": "401-456-2000",
            "fax_number": "401-456-2029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROSPECT CHARTERCARE RWMC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-25",
        "last_updated": "2021-01-11",
        "certification_date": "2021-01-11",
        "status": "A",
        "authorized_official_last_name": "ELDERS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "JON",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "714-788-1249"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nutritionist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Roger Williams Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Roger Williams Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Providence, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.