Individual provider Active NPI

Christian Moneke-Obiekwe

  • Physician Assistant
  • Providence, RI
National Provider Identifier
1366281289
Registry record updated May 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA01756 Issued in RI
Practice address
593 Eddy St
Providence, RI 02903-4923
Phone
(401) 444-6877
NPI assigned
May 21, 2024
Last updated
May 22, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2025

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 PA01756 RI Primary
Physician Assistant 363A00000X

Addresses

Primary practice location

593 Eddy St
Providence, RI 02903-4923

Mailing address

117 Ellenfield St Ste 101
Providence, RI 02905-4541
Phone (937) 204-6976

Other names 1

  • Christian Moneke Former name

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
I20250701002612 RI Practitioner - Physician Assistant 5799298915 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Interventional and Functional Pain CenterGroup PAC ID 1850635376, 3 clinicians

Practice addresses (Care Compare)

1150 Reservoir Ave
Suite 200
Cranston, RI 02920-6043
Phone (401) 648-6100

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA01756RIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lifespan Physician Group, Inc. CurrentSince Apr 19, 2025 Accepting new patients
Lifespan Physician Group, Inc. Physician Assistant CurrentSince Apr 19, 2025 Accepting new patients
Interventional and Functional Pain Center CurrentSince Apr 1, 2025 Accepting new patients

Locations

1150 Reservoir Ave
Ste 200
Cranston, RI 02920
Phone (401) 648-6100

1150 Reservoir Ave
Ste 303
Cranston, RI 02920
Phone (401) 228-6010

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
Providence, RI 02903

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1716249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747872000000",
    "number": "1366281289",
    "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": "029054541",
            "telephone_number": "937-204-6976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "593 EDDY ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034923",
            "telephone_number": "401-444-6877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONEKE-OBIEKWE",
        "first_name": "CHRISTIAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-05-21",
        "last_updated": "2025-05-22",
        "certification_date": "2025-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "RI",
            "license": "PA01756",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHRISTIAN",
            "last_name": "MONEKE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.