NPIMap

Organization Active NPI

Memorial Hospital

  • Diagnostic Neuroimaging (Psychiatry & Neurology) Physician
  • Pawtucket, RI
National Provider Identifier
1386863496
Registry record updated Nov 30, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Neuroimaging (Psychiatry & Neurology) PhysicianTaxonomy code 2084D0003X
Legal business name
MEMORIAL HOSPITAL
Practice address
111 Brewster St
Pawtucket, RI 02860-4400
Phone
(401) 729-2000
NPI assigned
Apr 25, 2007
Last updated
Nov 30, 2007By the provider in NPPES
Organization subpart
Yes
Parent organization
THE MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 30, 2007

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

Authorized official

Name
Mr. Francis R Dietz
Title
Ceo President
Phone
(401) 729-2000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Neuroimaging (Psychiatry & Neurology) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084D0003X Primary
Neurology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084N0400X

Addresses

Primary practice location

111 Brewster St
Pawtucket, RI 02860-4400

Mailing address

111 Brewster St
Pawtucket, RI 02860-4400
Phone (401) 729-2000

Other names 1

  • Memorial Hospital EEG Group Other name

National Provider Directory

National Provider Directory
Tax ID family
Andrew Bostom MD5 organizations share this tax ID, including this one
Part of
Andrew Bostom MD

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

111 Brewster St
Pawtucket, RI 02860
Phone (401) 729-2000

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196380800000",
    "number": "1386863496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 BREWSTER ST",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028604400",
            "telephone_number": "401-729-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 BREWSTER ST",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028604400",
            "telephone_number": "401-729-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE MEMORIAL HOSPITAL",
        "enumeration_date": "2007-04-25",
        "last_updated": "2007-11-30",
        "status": "A",
        "authorized_official_last_name": "DIETZ",
        "authorized_official_first_name": "FRANCIS",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO PRESIDENT",
        "authorized_official_telephone_number": "401-729-2000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2084D0003X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Diagnostic Neuroimaging",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Memorial Hospital EEG Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Pawtucket, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.