Active NPI
Diane Medeiros Gomes, PHARMD
- Pharmacist
- Providence, RI
National Provider Identifier
1356940860
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 25778
- Practice address
- 345 Blackstone Blvd
Providence, RI 02906-4800 - Phone
- (401) 455-6316
- NPI assigned
- Oct 26, 2020
- Last updated
- Oct 26, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 25778 | MA | Primary |
| Pharmacist | 183500000X | RPH04561 | RI |
Addresses
Primary practice location
345 Blackstone Blvd
Providence, RI 02906-4800
Mailing address
150 Ryan St
New Bedford, MA 02740-1473
Phone (774) 930-1564
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RPH04561 | Other | MA | MA LICENSE |
Other names 1
- Diane Medeiros
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | dimedeiros@butler.org |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25778 | MA | MD | Pharmacist |
| RPH04561 | RI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603670400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603670400000",
"number": "1356940860",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "150 RYAN ST",
"city": "NEW BEDFORD",
"state": "MA",
"postal_code": "027401473",
"telephone_number": "774-930-1564"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "345 BLACKSTONE BLVD",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029064800",
"telephone_number": "401-455-6316"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOMES",
"first_name": "DIANE",
"middle_name": "MEDEIROS",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-10-26",
"last_updated": "2020-10-26",
"certification_date": "2020-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MA",
"license": "25778",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "RI",
"license": "RPH04561",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MA LICENSE",
"identifier": "RPH04561",
"state": "MA"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "dimedeiros@butler.org",
"affiliation": "N",
"address_1": "150 Ryan St",
"city": "New Bedford",
"state": "MA",
"country_code": "US",
"postal_code": "027401473",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "DIANE",
"last_name": "MEDEIROS",
"credential": "PHARMD",
"code": "1",
"type": "Former Name"
}
]
}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 Oct 26, 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.