Individual provider Active NPI

Joanne Custodio, CRNA

  • Certified Registered Nurse Anesthetist
  • Providence, RI
National Provider Identifier
1447716527
Registry record updated Feb 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
APRN02006 Issued in RI
Practice address
825 Chalkstone Ave
Providence, RI 02908-4728
Phone
(401) 456-2000
NPI assigned
Feb 14, 2019
Last updated
Feb 22, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
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, MA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190311000899 RI Practitioner - Certified Registered Nurse Anesthetist (Crna) 3779822671 Reassigns benefits to 1 organization
I20191016002564 MA Practitioner - Certified Registered Nurse Anesthetist (Crna) 3779822671 Reassigns benefits to 2 organizations

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
Narragansett Bay Anesthesia LLCGroup PAC ID 5991774929, 95 clinicians

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

LicenseStateTypeSpecialty
APRN02006RIMDCertified Registered Nurse Anesthetist
RN50949RIMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Steward Medical Group, Inc Nurse Anesthetist, Certified Registered CurrentSince Aug 27, 2019 Accepting new patients
Steward Medical Group, Inc CurrentSince Aug 27, 2019 Accepting new patients
Narragansett Bay Anesthesia, LLC Nurse Anesthetist, Certified Registered CurrentSince Feb 15, 2019 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.

Hospital & facility affiliations 1

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": "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.

Verify at the official NPI Registry.