Active NPI
Joanne Custodio, CRNA
- Certified Registered Nurse Anesthetist
- Providence, RI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- APRN02006
- Practice address
- 825 Chalkstone Ave
Providence, RI 02908-4728 - Phone
- (401) 456-2000
- NPI assigned
- Feb 14, 2019
- Last updated
- Feb 22, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | RN2305195 | MA | |
| Certified Registered Nurse Anesthetist | 367500000X | RN50949 | RI | |
| Certified Registered Nurse Anesthetist | 367500000X | APRN02006 | RI | Primary |
Addresses
Primary practice location
825 Chalkstone Ave
Providence, RI 02908-4728
Mailing address
690 Canton St Ste 325
Westwood, MA 02090-2324
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in RI, MA
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
440 Swansea Mall Dr
Swansea, MA 02777-4114
Phone (508) 324-1171
825 Chalkstone Ave
Providence, RI 02908-4728
Phone (401) 456-2000
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| APRN02006 | RI | MD | Certified Registered Nurse Anesthetist |
| RN50949 | RI | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Steward Medical Group, Inc | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
| Steward Medical Group, Inc | Current | Accepting new patients | |
| Narragansett Bay Anesthesia, LLC | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
Locations
138 Haverhill St
Andover, MA 01810
Phone (978) 296-2302
77 Warren St
Fl 4
Brighton, MA 02135
Phone (617) 562-5450
795 Middle St
Fall River, MA 02721
Phone (508) 235-5046
440 Swansea Mall Dr
Swansea, MA 02777
Phone (508) 324-1171
88 Washington St
Taunton, MA 02780
Phone (508) 828-7000
690 Canton St
Ste 325
Westwood, MA 02090
Phone 7814077713307
200 High Service Ave
North Providence, RI 02904
Phone (401) 456-3000
825 Chalkstone Ave
Providence, RI 02908
Phone (401) 456-2000
Organizations & group practices 3
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.
-
- Anesthesiology Physician
- Warwick, RI
- NPI 1861445728
MA, Nurse Anesthetist, Certified Registered
-
- Anesthesiology Physician
- Fall River, MA
- NPI 1043711914
Nurse Anesthetist, Certified Registered
-
- Specialist
- Brighton, MA
- NPI 1356654495
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Roger Williams Medical Center
- General Acute Care Hospital
- Providence, RI
- NPI 1013332014
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1550102400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1550793600000",
"number": "1447716527",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "690 CANTON ST STE 325",
"city": "WESTWOOD",
"state": "MA",
"postal_code": "020902324"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "825 CHALKSTONE AVE",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029084728",
"telephone_number": "401-456-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CUSTODIO",
"first_name": "JOANNE",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-02-14",
"last_updated": "2019-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "MA",
"license": "RN2305195",
"primary": false
},
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "RI",
"license": "RN50949",
"primary": false
},
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "RI",
"license": "APRN02006",
"primary": true
}
],
"identifiers": [],
"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 Feb 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.