Active NPI
Wellness Connect Go Beyond Medicine, LLC
- Family Medicine Physician
- Providence, RI
National Provider Identifier
1487203303
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- WELLNESS CONNECT GO BEYOND MEDICINE, LLC
- Practice address
- 655 Broad St Ste 201
Providence, RI 02907-1444 - Phone
- (401) 642-0100
- Fax
- (833) 992-2318
- NPI assigned
- Sep 4, 2019
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Miriannys Rivas, FNP-C
- Title
- FNP-C
- Phone
- (401) 642-0100
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 6
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary | ||
| Internal Medicine Physician | 207R00000X | |||
| Gynecology Physician | 207VG0400X | |||
| Home Health Agency | 251E00000X | |||
| Urgent Care Clinic/Center | 261QU0200X | |||
| Family Nurse Practitioner | 363LF0000X |
Addresses
Primary practice location
655 Broad St Ste 201
Providence, RI 02907-1444
Mailing address
655 Broad St Ste 201
Providence, RI 02907-1444
Phone (401) 642-0100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in RI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200727002841 | RI | Part B Supplier - Clinic/Group Practice | 7517381312 |
Receives reassigned benefits from 3 practitioners Practice locations: Providence, RI |
National Provider Directory
National Provider Directory- Tax ID family
- Wellness Connect Go Beyond Medicine
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Home Health Agency
- Providence, RI
- NPI 1407771298
Member organizations 1
Organizations listed as members of this organization in the National Provider Directory.
Locations
170 Rhodes St
Providence, RI 02903
Phone (401) 390-0734
Interoperability endpoints
- https://api.platform.athenahealth.com/22477/brand/1/csg/1/fhir/r4
Ownership & related parties
Subparts reporting this organization as parent 1
Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.
-
- Home Health Agency
- Providence, RI
- NPI 1407771298
Practitioners & affiliated clinicians
Practitioners 4
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Internal Medicine Physician
- Providence, RI
- NPI 1174619878
RI, Single Specialty
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1567555200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1706054400000",
"number": "1487203303",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "655 BROAD ST STE 201",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029071444",
"telephone_number": "401-642-0100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "655 BROAD ST STE 201",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029071444",
"telephone_number": "401-642-0100",
"fax_number": "833-992-2318"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WELLNESS CONNECT GO BEYOND MEDICINE, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2019-09-04",
"last_updated": "2024-01-24",
"certification_date": "2024-01-24",
"status": "A",
"authorized_official_last_name": "RIVAS",
"authorized_official_first_name": "MIRIANNYS",
"authorized_official_title_or_position": "FNP-C",
"authorized_official_telephone_number": "401-642-0100",
"authorized_official_credential": "FNP-C"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
},
{
"code": "207R00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "207VG0400X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Obstetrics & Gynecology, Gynecology",
"state": null,
"license": null,
"primary": false
},
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "261QU0200X",
"taxonomy_group": "",
"desc": "Clinic/Center, Urgent Care",
"state": null,
"license": null,
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner, Family",
"state": null,
"license": null,
"primary": false
}
],
"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 Jan 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.