NPIMap

Organization Active NPI

DRS. Concannon and Vitale, LLC

  • Pediatrics Physician
  • Cranston, RI
National Provider Identifier
1366402018
Registry record updated Aug 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
DO-357 Issued in RI
Legal business name
DRS. CONCANNON AND VITALE, LLC
Practice address
1145 Reservoir Ave
Suite 124
Cranston, RI 02920-6055
Phone
(401) 943-7337
Fax
(401) 942-1509
NPI assigned
Mar 26, 2006
Organization subpart
No

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
41D0083835DRS Concannon & Vitale LLC1145 Reservoir Avenue Suite 124, Cranston, RI 02920Certificate of waiverOct 31, 2027

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110201000741 RI Part B Supplier - Clinic/Group Practice 2567641954 Receives reassigned benefits from 2 practitioners
Practice locations: Cranston, RI

National Provider Directory

National Provider Directory

Locations

1145 Reservoir Ave
Ste 124
Cranston, RI 02920
Phone (401) 943-7337

NPPES NPI Registry

Updated by the provider on Aug 13, 2025

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

Authorized official

Name
Dr. John E Concannon, DONPI 1962409128
Title
Senior Partner
Phone
(401) 943-7337

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X DO-357 RI Primary

Addresses

Primary practice location

1145 Reservoir Ave
Suite 124
Cranston, RI 02920-6055

Mailing address

1145 Reservoir Ave
Suite 124
Cranston, RI 02920-6055
Phone (401) 943-7337

Other identifiers 1

IdentifierTypeStateIssuer
601200661MedicaidRI

Other names 2

  • Atlantic Pediatrics Doing business as
  • Drs. Concannon & Vitale, LLC Former legal business name

NPI Registry JSON

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

{
    "created_epoch": "1143331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755043200000",
    "number": "1366402018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1145 RESERVOIR AVE",
            "address_2": "SUITE 124",
            "city": "CRANSTON",
            "state": "RI",
            "postal_code": "029206055",
            "telephone_number": "401-943-7337",
            "fax_number": "401-942-1509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1145 RESERVOIR AVE",
            "address_2": "SUITE 124",
            "city": "CRANSTON",
            "state": "RI",
            "postal_code": "029206055",
            "telephone_number": "401-943-7337",
            "fax_number": "401-942-1509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DRS. CONCANNON AND VITALE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-26",
        "last_updated": "2025-08-13",
        "certification_date": "2025-08-13",
        "status": "A",
        "authorized_official_last_name": "CONCANNON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "SENIOR PARTNER",
        "authorized_official_telephone_number": "401-943-7337",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "RI",
            "license": "DO-357",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "601200661",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Atlantic Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Drs. Concannon & Vitale, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Drs. Concannon & Vitale, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Cranston, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.