NPIMap

Organization Active NPI

Gateway Healthcare, Inc

  • Specialist
  • Pawtucket, RI
National Provider Identifier
1477583706
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
MD100002 Issued in RI
Legal business name
GATEWAY HEALTHCARE, INC
Practice address
249 Roosevelt Ave
Ste 205
Pawtucket, RI 02860-2134
Phone
(401) 724-8400
Fax
(401) 365-1100
NPI assigned
Jul 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Pedro Tactacan
Title
Cred Coordinator
Phone
(401) 724-8400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X MD100002 RI Primary

Addresses

Primary practice location

249 Roosevelt Ave
Ste 205
Pawtucket, RI 02860-2134

Mailing address

249 Roosevelt Ave
Ste 205
Pawtucket, RI 02860-2134
Phone (401) 724-8400

Other identifiers 1

IdentifierTypeStateIssuer
PT44450MedicaidRI

National Provider Directory

National Provider Directory
Tax ID family
Gateway Healthcare Inc21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

Organizations that report the same tax identification number in the National Provider Directory.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1477583706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "249 ROOSEVELT AVE",
            "address_2": "STE 205",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028602134",
            "telephone_number": "401-724-8400",
            "fax_number": "401-365-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "249 ROOSEVELT AVE",
            "address_2": "STE 205",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028602134",
            "telephone_number": "401-724-8400",
            "fax_number": "401-365-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GATEWAY HEALTHCARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TACTACAN",
        "authorized_official_first_name": "PEDRO",
        "authorized_official_title_or_position": "CRED COORDINATOR",
        "authorized_official_telephone_number": "401-724-8400"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "RI",
            "license": "MD100002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PT44450",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pawtucket, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.