Individual provider Active NPI

Satori Iwamoto, M.D.

  • Dermatology Physician
  • Providence, RI
National Provider Identifier
1609820604
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
11161 Issued in RI
Practice address
50 Maude St
Providence, RI 02908-4325
Phone
(401) 456-2327
NPI assigned
May 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 11161 RI Primary

Addresses

Primary practice location

50 Maude St
Providence, RI 02908-4325

Mailing address

50 Maude St
Providence, RI 02908-4325
Phone (401) 456-5368

Other identifiers 1

IdentifierTypeStateIssuer
9024198MedicaidRI

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050422000378 RI Practitioner - DermatologyPractitioner - Internal Medicine 4385682079 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11161RIMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prospect Chartercare Physicians, LLC Dermatology CurrentSince Jun 20, 2014 Accepting new patients

Locations

1681 Cranston St
Cranston, RI 02920
Phone (401) 944-6889

825 Chalkstone Ave
Providence, RI 02908
Phone (401) 456-2000

50 Maude St
Providence, RI 02908
Phone (401) 456-2200

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.

NPI Registry JSON

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

{
    "created_epoch": "1148256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1609820604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 MAUDE ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029084325",
            "telephone_number": "401-456-5368",
            "fax_number": "401-456-5782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 MAUDE ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029084325",
            "telephone_number": "401-456-2327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IWAMOTO",
        "first_name": "SATORI",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-22",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "RI",
            "license": "11161",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9024198",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.