NPIMap

Individual provider Active NPI

Mridula Menon, MD

  • Internal Medicine Physician
  • Lincoln, RI
National Provider Identifier
1427045301
Registry record updated Apr 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD11557 Issued in RI
Practice address
6 Blackstone Valley PL
Suite 701
Lincoln, RI 02865-1179
Phone
(401) 333-3111
Fax
(401) 334-1217
NPI assigned
Oct 5, 2005
Last updated
Apr 2, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD11557 RI Primary

Addresses

Primary practice location

6 Blackstone Valley PL
Suite 701
Lincoln, RI 02865-1179

Mailing address

10 Davol SQ
Suite 400
Providence, RI 02903-4754
Phone (401) 421-4000

Other identifiers 1

IdentifierTypeStateIssuer
2081156MedicaidMA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mmenon220846@direct.lifespan.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110805000052 RI Practitioner - Internal Medicine 6406817261 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Coastal Medical Physicians IncGroup PAC ID 0345658316, 222 clinicians

Practice addresses (Care Compare)

6 Blackstone Valley PL
Suite 701
Lincoln, RI 02865-1170
Phone (401) 333-3111

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Coastal Medical Physicians, Inc. Internal Medicine CurrentSince Apr 25, 2021 Accepting new patients
Coastal Medical Physicians, Inc. Internal Medicine CurrentSince Apr 25, 2021 Accepting new patients
Lifespan Corporation Current Accepting new patients
Coastal Medical, Inc. Past Accepting new patients
Nexis Healthcare, Inc. Past Accepting new patients

Locations

900 Warren Ave
Ste 401
East Providence, RI 02914
Phone (401) 330-2480

6 Blackstone Valley Pl
Ste 701
Lincoln, RI 02865
Phone (401) 333-3111

Interoperability endpoints

  • Direct secure messaging: mmenon220846@brownhealth.medalliesdirect.net

Organizations & group practices 5

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.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1128470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712016000000",
    "number": "1427045301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 DAVOL SQ",
            "address_2": "SUITE 400",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034754",
            "telephone_number": "401-421-4000",
            "fax_number": "401-272-1456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 BLACKSTONE VALLEY PL",
            "address_2": "SUITE 701",
            "city": "LINCOLN",
            "state": "RI",
            "postal_code": "028651179",
            "telephone_number": "401-333-3111",
            "fax_number": "401-334-1217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENON",
        "first_name": "MRIDULA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-05",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "RI",
            "license": "MD11557",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2081156",
            "state": "MA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmenon220846@direct.lifespan.org",
            "affiliation": "N",
            "address_1": "6 Blackstone Valley Pl",
            "address_2": "Suite 701",
            "city": "Lincoln",
            "state": "RI",
            "country_code": "US",
            "postal_code": "028651179",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lincoln, RI

Sources for this page

Verify at the official NPI Registry.