Individual provider Active NPI

Jennifer C Rao, PA

  • Physician Assistant
  • Warwick, RI
National Provider Identifier
1538434634
Registry record updated May 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA00355 Issued in RI
Practice address
125 Metro Center Boulevard
Suite 2000
Warwick, RI 02886-1768
Phone
(401) 432-2500
Fax
(401) 453-8220
NPI assigned
Mar 21, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 20, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA00355 RI Primary

Addresses

Primary practice location

125 Metro Center Boulevard
Suite 2000
Warwick, RI 02886-1768

Mailing address

125 Metro Center Boulevard
Suite 2000
Warwick, RI 02886-1768
Phone (401) 432-2500

Other practice location 1

455 Toll Gate Rd
Warwick, RI 02886-2759
Phone (401) 737-7010

Other practice location 2

101 Dudley St
Providence, RI 02905-2401
Phone (401) 453-7950

Other names 1

  • Jennifer C Fuller Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050214000883 RI Practitioner - Physician Assistant 8820040231 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Affinity Physicians LLC.Group PAC ID 0244413391, 723 clinicians

Practice addresses (Care Compare)

455 Toll Gate Rd
Warwick, RI 02886-2759
Phone (401) 737-7010

455 Tollgate Rd
Warwick, RI 02886-2759

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Affinity Physicians LLC CurrentSince Jan 26, 2020 Accepting new patients
Lifespan Physician Group, Inc. Past Accepting new patients
Southcoast Physicians Group, Inc. Past Accepting new patients

Locations

101 Dudley St
Providence, RI 02905
Phone (401) 453-7950

455 Toll Gate Rd
Warwick, RI 02886
Phone (401) 737-7000

Organizations & group practices 4

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 3

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": "1332288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747699200000",
    "number": "1538434634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 METRO CENTER BOULEVARD",
            "address_2": "SUITE 2000",
            "city": "WARWICK",
            "state": "RI",
            "postal_code": "028861768",
            "telephone_number": "401-432-2500",
            "fax_number": "401-453-8220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 METRO CENTER BOULEVARD",
            "address_2": "SUITE 2000",
            "city": "WARWICK",
            "state": "RI",
            "postal_code": "028861768",
            "telephone_number": "401-432-2500",
            "fax_number": "401-453-8220"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "455 Toll Gate Rd",
            "address_purpose": "LOCATION",
            "city": "Warwick",
            "state": "RI",
            "postal_code": "028862759",
            "country_code": "US",
            "telephone_number": "401-737-7010",
            "fax_number": "401-736-4546",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "101 Dudley St",
            "address_purpose": "LOCATION",
            "city": "Providence",
            "state": "RI",
            "postal_code": "029052401",
            "country_code": "US",
            "telephone_number": "401-453-7950",
            "fax_number": "401-453-7658",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAO",
        "first_name": "JENNIFER",
        "middle_name": "C",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-21",
        "last_updated": "2025-05-20",
        "certification_date": "2025-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "RI",
            "license": "PA00355",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "FULLER",
            "middle_name": "C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Warwick, RI

Sources for this page

Verify at the official NPI Registry.