Individual provider Active NPI

Edward McGookin, MD

  • Pediatrics Physician
  • East Providence, RI
National Provider Identifier
1427045905
Registry record updated Apr 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
MD09577 Issued in RI
Practice address
900 Warren Ave
Suite 200
East Providence, RI 02914-1430
Phone
(401) 421-6481
Fax
(401) 751-8734
NPI assigned
Sep 30, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MD09577 RI Primary

Addresses

Primary practice location

900 Warren Ave
Suite 200
East Providence, RI 02914-1430

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
709004047OtherRIGROUP MEDICARE
9002715MedicaidRI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address emcgookin221607@direct.lifespan.org

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050223000135 RI Practitioner - Pediatric Medicine 4688627334 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD09577RIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lifespan Corporation Current Accepting new patients
Coastal Medical Physicians, Inc. CurrentSince Apr 25, 2021 Accepting new patients
Coastal Medical Physicians, Inc. Pediatrics CurrentSince Apr 25, 2021 Accepting new patients
Coastal Medical, Inc. Past Accepting new patients
Memorial Hospital Past Accepting new patients

Locations

900 Warren Ave
Ste 200
East Providence, RI 02914
Phone (401) 421-6481

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

300 Centerville Rd
Ste 110
Warwick, RI 02886
Phone (401) 615-2299

300 Centerville Rd
Warwick, RI 02886
Phone (401) 615-2299

Interoperability endpoints

  • Direct secure messaging: emcgookin221607@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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1128038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712620800000",
    "number": "1427045905",
    "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": "900 WARREN AVE",
            "address_2": "SUITE 200",
            "city": "EAST PROVIDENCE",
            "state": "RI",
            "postal_code": "029141430",
            "telephone_number": "401-421-6481",
            "fax_number": "401-751-8734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCGOOKIN",
        "first_name": "EDWARD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-30",
        "last_updated": "2024-04-09",
        "certification_date": "2024-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "RI",
            "license": "MD09577",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICARE",
            "identifier": "709004047",
            "state": "RI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9002715",
            "state": "RI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "emcgookin221607@direct.lifespan.org",
            "affiliation": "N",
            "address_1": "300 Centerville Rd Ste 110",
            "city": "Warwick",
            "state": "RI",
            "country_code": "US",
            "postal_code": "028860200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in East Providence, RI

Sources for this page

Verify at the official NPI Registry.