Individual provider Active NPI

Heidi Jimenez

  • Acute Care Nurse Practitioner
  • Providence, RI
National Provider Identifier
1356847172
Registry record updated May 31, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
APRN01789 Issued in RI
Practice address
164 Summit Ave
Providence, RI 02906
Phone
(401) 793-4102
Fax
(401) 793-4049
NPI assigned
Apr 2, 2018
Last updated
May 31, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 31, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X APRN01789 RI Primary

Addresses

Primary practice location

164 Summit Ave
Providence, RI 02906

Mailing address

117 Ellenfield St Ste 101
Providence, RI 02905-4513
Phone (401) 444-6779

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
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 1

Enrollment IDStateProvider typePAC IDDetails
I20180618000207 RI Practitioner - Nurse Practitioner 7517212475 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
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

593 Eddy St
Providence, RI 02903-4923

593 Eddy St Apc
Suite 6
Providence, RI 02903-4923
Phone (401) 793-9172

593 Eddy St George BLDG 1St Floor
Providence, RI 02903-4923
Phone (401) 793-9166

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Lifespan Physician Group, Inc. CurrentSince Jul 11, 2018 Accepting new patients
The Miriam Hospital CurrentSince Jul 1, 2020 Accepting new patients
The Miriam Hospital Current Accepting new patients
Rhode Island Hospital Acute Care CurrentSince Jan 16, 2024 Accepting new patients
Rhode Island Hospital CurrentSince Jan 16, 2024 Accepting new patients
The Miriam Hospital Current Accepting new patients
The Miriam Hospital CurrentSince Jul 1, 2020 Accepting new patients
Lifespan Physician Group, Inc. CurrentSince Jul 11, 2018 Accepting new patients
Lifespan Physician Group, Inc. Past Accepting new patients

Locations

1454 S County Trl
Ste 2200
East Greenwich, RI 02818
Phone (401) 444-8516

950 Warren Ave
Ste 201
East Providence, RI 02914
Phone (855) 332-8474

950 Warren Ave
Fl 2
East Providence, RI 02914

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

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

593 Eddy St
Bldg 1ST
Providence, RI 02903
Phone (401) 444-3777

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

593 Eddy St
Providence, RI 02903

208 Collyer St
Ste 100
Providence, RI 02904
Phone (401) 793-7191

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 6

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": "1522627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527724800000",
    "number": "1356847172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 ELLENFIELD ST STE 101",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029054513",
            "telephone_number": "401-444-6779"
        },
        {
            "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": "401-793-4102",
            "fax_number": "401-793-4049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIMENEZ",
        "first_name": "HEIDI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-02",
        "last_updated": "2018-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "RI",
            "license": "APRN01789",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.