Individual provider Active NPI

Marcel Abel Bavoux, D.O.

  • Internal Medicine Physician
  • Johnston, RI
National Provider Identifier
1508990557
Registry record updated Jun 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
00414 Issued in RI
Practice address
1239 Hartford Ave Ste 3B
Johnston, RI 02919-7137
Phone
(401) 209-1760
Fax
(401) 209-1761
NPI assigned
Mar 14, 2007
Last updated
Jun 11, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 11, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 00414 RI Primary

Addresses

Primary practice location

1239 Hartford Ave Ste 3B
Johnston, RI 02919-7137

Mailing address

1239 Hartford Ave Ste 3B
Johnston, RI 02919-7137
Phone (401) 209-1760

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI, CT2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040205000296 RI Practitioner - Internal Medicine 6103719968 Reassigns benefits to 2 organizations
I20200302000425 CT Practitioner - Internal Medicine 6103719968

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of New England, College of Osteo Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mdri LLCGroup PAC ID 6406291632, 17 clinicians

Practice addresses (Care Compare)

1239 Hartford Ave
Suite 3
Johnston, RI 02919-7137
Phone (401) 209-1730

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
00414RIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medicine and Long Term Care Associates, LLC Internal Medicine CurrentSince Dec 1, 2019 Accepting new patients
Mdri LLC CurrentSince Jun 1, 2025 Accepting new patients
Mdri LLC CurrentSince Jun 1, 2025 Accepting new patients

Locations

333 Budlong Rd
Cranston, RI 02920
Phone (401) 943-4530

1407 S County Trl
Ste 431
East Greenwich, RI 02818
Phone (401) 234-1912

1239 Hartford Ave
Ste 3
Johnston, RI 02919
Phone (401) 209-1730

1239 Hartford Ave
Ste 3B
Johnston, RI 02919
Phone (401) 209-1760

2 Wake Robin Rd
Ste 205
Lincoln, RI 02865
Phone (401) 333-9044

6 Blackstone Valley Pl
Ste 706
Lincoln, RI 02865

Interoperability endpoints

  • Direct secure messaging: marcel.bavoux.1@29391.direct.athenahealth.com

Organizations & group practices 3

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.

Hospital & facility affiliations 2

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": "1173830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781136000000",
    "number": "1508990557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1239 HARTFORD AVE STE 3B",
            "city": "JOHNSTON",
            "state": "RI",
            "postal_code": "029197137",
            "telephone_number": "401-209-1760",
            "fax_number": "401-209-1761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1239 HARTFORD AVE STE 3B",
            "city": "JOHNSTON",
            "state": "RI",
            "postal_code": "029197137",
            "telephone_number": "401-209-1760",
            "fax_number": "401-209-1761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAVOUX",
        "first_name": "MARCEL",
        "middle_name": "ABEL",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-14",
        "last_updated": "2026-06-11",
        "certification_date": "2026-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "RI",
            "license": "00414",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnston, RI

Sources for this page

Verify at the official NPI Registry.