NPIMap

Organization Active NPI

Brown Neurology

  • Neurology Physician
  • Providence, RI
National Provider Identifier
1366486102
Registry record updated May 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
BROWN NEUROLOGY
Practice address
593 Eddy Street
Apc 5
Providence, RI 02903
Phone
(401) 444-3032
Fax
(401) 444-3205
NPI assigned
Jun 15, 2006
Organization subpart
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

Authorized official

Name
Jessica L Domingos
Title
Credentialing Specialist
Phone
(401) 443-5122

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084N0400X Primary

Addresses

Primary practice location

593 Eddy Street
Apc 5
Providence, RI 02903

Mailing address

110 Elm St FL 1
Providence, RI 02903-4626
Phone (401) 444-7016

Other practice location 1

1 James P Murphy Ind Hwy Ste 120
West Warwick, RI 02893-2366
Phone (401) 606-4600

Other practice location 2

900 Douglas Pike
Smithfield, RI 02917-1879
Phone (401) 618-5507

Other identifiers 2

IdentifierTypeStateIssuer
NF07469MedicaidRI
1366486102MedicaidRI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040317000511 RI Part B Supplier - Clinic/Group Practice 2163312869 Receives reassigned benefits from 24 practitioners
Practice locations: Providence, RI; West Warwick, RI; Smithfield, RI

National Provider Directory

National Provider Directory

Locations

2 Dudley St
Ste 530
Providence, RI 02905
Phone (401) 444-3799

593 Eddy St
Fl Apc
Providence, RI 02903

593 Eddy St
Fl 5
Providence, RI 02903
Phone (401) 444-4741

110 Elm St
Fl 1
Providence, RI 02903

593 Eddy St
#7
Providence, RI 02903
Phone (401) 444-3565

110 Elm St
Fl 2
Providence, RI 02903

593 Eddy St
#55
Providence, RI 02903

34 Parsonage St
#191
Providence, RI 02903

900 Douglas Pike
Ste A3
Smithfield, RI 02917

1 James P Murphy Ind Hwy
Ste 1
West Warwick, RI 02893

Practitioners & affiliated clinicians

Practitioners 43

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

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747872000000",
    "number": "1366486102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 ELM ST FL 1",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034626",
            "telephone_number": "401-444-7016",
            "fax_number": "401-444-3205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "593 EDDY STREET",
            "address_2": "APC 5",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "02903",
            "telephone_number": "401-444-3032",
            "fax_number": "401-444-3205"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 James P Murphy Ind Hwy Ste 120",
            "address_purpose": "LOCATION",
            "city": "West Warwick",
            "state": "RI",
            "postal_code": "028932366",
            "country_code": "US",
            "telephone_number": "401-606-4600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "900 Douglas Pike",
            "address_purpose": "LOCATION",
            "city": "Smithfield",
            "state": "RI",
            "postal_code": "029171879",
            "country_code": "US",
            "telephone_number": "401-618-5507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BROWN NEUROLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-15",
        "last_updated": "2025-05-22",
        "certification_date": "2025-05-22",
        "status": "A",
        "authorized_official_last_name": "DOMINGOS",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "401-443-5122"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NF07469",
            "state": "RI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1366486102",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 May 22, 2025; 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.