Providence Interventional Associates II LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

PROVIDENCE INTERVENTIONAL ASSOCIATES II LLC

Practice address

100 Highland Ave Ste 100
Providence, RI 02906-2740

Phone

(401) 277-9729

Fax

(401) 277-9730

NPI assigned

Oct 5, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Jonah Licht, MDNPI 1134192891

Title

Owner

Phone

(401) 277-9729

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Providence Access Care Doing business as

Medicare fee-for-service enrollment

Enrolled in RI

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Providence Interventional Associates II LLC

  • Vascular & Interventional Radiology Physician
  • Providence, RI
  • NPI 1306123476

  6204094212

  Same PAC ID

Listed as

Providence Access CareCCN 41C0001019

Medicare certification status

ActiveFrom the Provider of Services file

Tax ID family

Providence Access Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Providence Interventional Associates II LLC

  • Vascular & Interventional Radiology Physician
  • Providence, RI
  • NPI 1306123476
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jonah M Licht, MD

  • Nephrology Physician
  • Providence, RI
  • NPI 1134192891
  NPD Authorized official

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

{
    "created_epoch": "1538697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749772800000",
    "number": "1497220412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 HIGHLAND AVE STE 100",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029062740",
            "telephone_number": "401-277-9729",
            "fax_number": "401-277-9730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HIGHLAND AVE STE 100",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029062740",
            "telephone_number": "401-277-9729",
            "fax_number": "401-277-9730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE INTERVENTIONAL ASSOCIATES II LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-05",
        "last_updated": "2025-06-13",
        "certification_date": "2025-06-13",
        "status": "A",
        "authorized_official_last_name": "LICHT",
        "authorized_official_first_name": "JONAH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "401-277-9729",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1497220412",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Providence Access Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Providence Dental PC
• Providence Dental Sleep Center LLC
• Providence Eye Associates, Inc.
• Providence Integrative Wellness
• Providence Interventional Associates II LLC
• Providence Medical Healthcare Center
• Providence Medical Supplies
• Providence Metro Treatment Center
• Providence Nutrition, LLC
• Providence Orthodontics, LLC

• Ambulatory Surgical Clinic/Center in Providence, RI
• Providers in Providence, RI by specialty
• Ambulatory Surgical Clinic/Center in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2025; 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.