Individual provider Active NPI

Brendan T Scanlon, PA

  • Physician Assistant
  • Cranston, RI
National Provider Identifier
1437862034
Registry record updated Mar 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA01671 Issued in RI
Practice address
75 Sockanosset Cross Rd Ste 100
Cranston, RI 02920-5558
Phone
(401) 946-6200
NPI assigned
Dec 29, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA01671 RI Primary

Addresses

Primary practice location

75 Sockanosset Cross Rd Ste 100
Cranston, RI 02920-5558

Mailing address

75 Sockanosset Cross Rd Ste 100
Cranston, RI 02920-5558
Phone (401) 946-6200

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240329002228 RI Practitioner - Physician Assistant 3971941733 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
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)

1500 Pontiac Ave
Suite 101
Cranston, RI 02920-4486
Phone (401) 944-4300

75 Sockanosset Cross Rd
Cranston, RI 02920-5558
Phone (401) 946-6200

900 Warren Ave
East Providence, RI 02914-1430

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA01671RIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lifespan Corporation Current Accepting new patients
Coastal Medical Physicians, Inc. CurrentSince Apr 1, 2024 Accepting new patients
Coastal Medical, Inc. Past Accepting new patients

Locations

75 Sockanosset Cross Rd
Ste 100
Cranston, RI 02920
Phone (401) 736-4500

1500 Pontiac Ave
Ste 101
Cranston, RI 02920
Phone (401) 371-0223

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

Interoperability endpoints

  • Direct secure messaging: bscanlon223752@brownhealth.medalliesdirect.net

Organizations & group practices 4

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.

Hospital & facility affiliations 5

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": "1672272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710806400000",
    "number": "1437862034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 SOCKANOSSET CROSS RD STE 100",
            "city": "CRANSTON",
            "state": "RI",
            "postal_code": "029205558",
            "telephone_number": "401-946-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 SOCKANOSSET CROSS RD STE 100",
            "city": "CRANSTON",
            "state": "RI",
            "postal_code": "029205558",
            "telephone_number": "401-946-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCANLON",
        "first_name": "BRENDAN",
        "middle_name": "T",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-12-29",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "RI",
            "license": "PA01671",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cranston, RI

Sources for this page

Verify at the official NPI Registry.