NPIMap

Individual provider Active NPI

Antioan Kardous, MD

  • Internal Medicine Physician
  • Cranston, RI
National Provider Identifier
1538142252
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
10089 Issued in RI
Practice address
1145 Reservoir Ave
Suite 301
Cranston, RI 02920-6055
Phone
(401) 946-5001
Fax
(401) 946-5101
NPI assigned
Nov 28, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 10089 RI Primary

Addresses

Primary practice location

1145 Reservoir Ave
Suite 301
Cranston, RI 02920-6055

Mailing address

1145 Reservoir Ave
Suite 301
Cranston, RI 02920-6055
Phone (401) 946-5001

Other identifiers 5

IdentifierTypeStateIssuer
2847513OtherAETNA
272209OtherRIBLUE CROSS BLUE SHIELD
408195OtherRIBLUE CHIP
AK35758MedicaidRI
P00083165OtherRAILROAD MEDICARE

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
I20040224001282 RI Practitioner - Internal Medicine 1557257706 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1145 Reservoir Ave
Suite 301
Cranston, RI 02920-6000
Phone (401) 946-5001

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10089RIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kardous Primary Care Inc Internal Medicine CurrentSince Jul 22, 2002 Accepting new patients

Locations

1150 Reservoir Ave
Ste 305B
Cranston, RI 02920
Phone (401) 942-8080

1145 Reservoir Ave
Ste 301
Cranston, RI 02920
Phone (401) 946-5001

Organizations & group practices 1

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 11

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": "1133136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1538142252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1145 RESERVOIR AVE",
            "address_2": "SUITE 301",
            "city": "CRANSTON",
            "state": "RI",
            "postal_code": "029206055",
            "telephone_number": "401-946-5001",
            "fax_number": "401-946-5101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1145 RESERVOIR AVE",
            "address_2": "SUITE 301",
            "city": "CRANSTON",
            "state": "RI",
            "postal_code": "029206055",
            "telephone_number": "401-946-5001",
            "fax_number": "401-946-5101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KARDOUS",
        "first_name": "ANTIOAN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "RI",
            "license": "10089",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "2847513",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "272209",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHIP",
            "identifier": "408195",
            "state": "RI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "AK35758",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00083165",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cranston, RI

Sources for this page

Verify at the official NPI Registry.