Individual provider Active NPI

Thomas Crowley Miglietta, PA

  • Physician Assistant
  • Wakefield, RI
National Provider Identifier
1457847790
Registry record updated Oct 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA01444 Issued in RI
Practice address
100 Kenyon Ave
Wakefield, RI 02879-4216
Phone
(401) 782-8000
NPI assigned
Jul 10, 2018
Last updated
Oct 2, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X PA01444 RI Primary

Addresses

Primary practice location

100 Kenyon Ave
Wakefield, RI 02879-4216

Mailing address

2 Maynard St
Potsdam, NY 13676-1129
Phone (203) 470-6446

Other practice location 1

50 LeRoy St
Potsdam, NY 13676-1799
Phone (315) 265-3300

Other identifiers 1

IdentifierTypeStateIssuer
1457847790MedicaidRI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, RI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20181026000620 NY Practitioner - Physician Assistant 0042563751 Reassigns benefits to 2 organizations
I20220916000978 RI Practitioner - Physician Assistant 0042563751 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
022327NYMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Canton-Potsdam Hospital CurrentSince Jul 23, 2018 Accepting new patients
Canton-Potsdam Hospital CurrentSince Jul 23, 2018 Accepting new patients
Massena Hospital Inc CurrentSince Sep 1, 2021 Accepting new patients

Locations

1 Hospital Dr
Massena, NY 13662
Phone (315) 764-1711

201 Market St
Ste E
Potsdam, NY 13676
Phone (315) 274-9102

50 Leroy St
Potsdam, NY 13676
Phone (315) 261-6034

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1531180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696204800000",
    "number": "1457847790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 MAYNARD ST",
            "city": "POTSDAM",
            "state": "NY",
            "postal_code": "136761129",
            "telephone_number": "203-470-6446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 KENYON AVE",
            "city": "WAKEFIELD",
            "state": "RI",
            "postal_code": "028794216",
            "telephone_number": "401-782-8000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "50 LeRoy St",
            "address_purpose": "LOCATION",
            "city": "Potsdam",
            "state": "NY",
            "postal_code": "136761799",
            "country_code": "US",
            "telephone_number": "315-265-3300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIGLIETTA",
        "first_name": "THOMAS",
        "middle_name": "CROWLEY",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-10",
        "last_updated": "2023-10-02",
        "certification_date": "2022-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "RI",
            "license": "PA01444",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1457847790",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wakefield, RI

Sources for this page

Verify at the official NPI Registry.