NPIMap

Individual provider Active NPI

Susanne J Patrick-Mackinnon, MD

  • Neurology Physician
  • Portsmouth, RI
National Provider Identifier
1477500783
Registry record updated Feb 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
MD09030 Issued in RI
Practice address
2444 E Main Rd
Portsmouth, RI 02871-4025
Phone
(401) 683-1048
Fax
(401) 683-1239
NPI assigned
May 30, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X MD09030 RI Primary

Addresses

Primary practice location

2444 E Main Rd
Portsmouth, RI 02871-4025

Mailing address

200 Mill Rd
Suite 180
Fairhaven, MA 02719-5252
Phone (508) 973-2000

Other identifiers 1

IdentifierTypeStateIssuer
7005007MedicaidRI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101119000702 RI Practitioner - Neurology 6002986882 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
University of Massachusetts Medical School, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lifespan Physician Group IncGroup PAC ID 2567455082, 1,151 clinicians

Practice addresses (Care Compare)

19 Friendship St
Suite 150 160
Newport, RI 02840-2272
Phone (401) 845-3800

Hospital & facility affiliations

  • Visiting Nurse Home and Hospice Home health agency, Middleton, RI, CCN 417000
  • Newport Hospital Hospital, Newport, RI, CCN 410006
  • The Miriam Hospital Hospital, Providence, RI, CCN 410012
  • Rhode Island Hospital Hospital, Providence, RI, CCN 410007
  • Southcoast Hospitals Group Hospital, Fall River, MA, CCN 220074

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD09030RIMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lifespan Physician Group, Inc. CurrentSince Mar 29, 2015 Accepting new patients
Lifespan Physician Group, Inc. CurrentSince Mar 29, 2015 Accepting new patients
Lifespan Physician Group, Inc. Neurology Past Accepting new patients
Bristol Neurology, Inc Neurology PastSince Jan 1, 2008 Accepting new patients

Locations

19 Friendship St
Ste 150160
Newport, RI 02840
Phone (401) 845-3800

11 Friendship St
Newport, RI 02840
Phone (401) 845-1110

19 Friendship St
Unit 300
Newport, RI 02840
Phone (401) 324-6061

185A High Service Ave
North Providence, RI 02904
Phone (401) 354-6050

79 Turnpike Ave
Portsmouth, RI 02871
Phone (401) 683-7434

77 Turnpike Ave
Portsmouth, RI 02871
Phone (401) 683-2290

117 Ellenfield St
Ste 101
Providence, RI 02905
Phone (401) 444-4318

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 8

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": "1148947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455667200000",
    "number": "1477500783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 MILL RD",
            "address_2": "SUITE 180",
            "city": "FAIRHAVEN",
            "state": "MA",
            "postal_code": "027195252",
            "telephone_number": "508-973-2000",
            "fax_number": "508-973-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2444 E MAIN RD",
            "city": "PORTSMOUTH",
            "state": "RI",
            "postal_code": "028714025",
            "telephone_number": "401-683-1048",
            "fax_number": "401-683-1239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATRICK-MACKINNON",
        "first_name": "SUSANNE",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-30",
        "last_updated": "2016-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "RI",
            "license": "MD09030",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7005007",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portsmouth, RI

Sources for this page

Verify at the official NPI Registry.