NPIMap

Organization Active NPI

Lifestyle Medicine of Rhode Island, LLC

  • Family Medicine Physician
  • Johnston, RI
National Provider Identifier
1568978690
Registry record updated Dec 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD04110 Issued in RI
Legal business name
LIFESTYLE MEDICINE OF RHODE ISLAND, LLC
Practice address
1524 Atwood Ave Ste 336
Johnston, RI 02919-3228
Phone
(401) 228-6844
Fax
(401) 228-6855
NPI assigned
Dec 27, 2017
Last updated
Dec 27, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2017

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

Authorized official

Name
Mrs. Martha Mary Fontaine
Title
Practice Manager
Phone
(401) 228-6844

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD04110 RI Primary
Obesity Medicine (Family Medicine) Physician 207QB0002X MD04110 RI
Obesity Medicine (Preventive Medicine) Physician 2083B0002X MD04110 RI

Addresses

Primary practice location

1524 Atwood Ave Ste 336
Johnston, RI 02919-3228

Mailing address

1524 Atwood Ave Ste 336
Johnston, RI 02919-3228
Phone (401) 228-6844

Other names 1

  • RI Weightloss, LLC Former legal business name

National Provider Directory

National Provider Directory

Locations

1524 Atwood Ave
Ste 336
Johnston, RI 02919
Phone (401) 228-6844

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1514332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1514332800000",
    "number": "1568978690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1524 ATWOOD AVE STE 336",
            "city": "JOHNSTON",
            "state": "RI",
            "postal_code": "029193228",
            "telephone_number": "401-228-6844",
            "fax_number": "401-228-6855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1524 ATWOOD AVE STE 336",
            "city": "JOHNSTON",
            "state": "RI",
            "postal_code": "029193228",
            "telephone_number": "401-228-6844",
            "fax_number": "401-228-6855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESTYLE MEDICINE OF RHODE ISLAND, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-27",
        "last_updated": "2017-12-27",
        "status": "A",
        "authorized_official_last_name": "FONTAINE",
        "authorized_official_first_name": "MARTHA",
        "authorized_official_middle_name": "MARY",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "401-228-6844",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "RI",
            "license": "MD04110",
            "primary": true
        },
        {
            "code": "207QB0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Obesity Medicine",
            "state": "RI",
            "license": "MD04110",
            "primary": false
        },
        {
            "code": "2083B0002X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Obesity Medicine",
            "state": "RI",
            "license": "MD04110",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RI Weightloss, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Johnston, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.