Peter George Brassard, M.D.
Individual provider Active NPI Family Medicine Physician · East Providence, RI
NPI 1609877489 · NPPES record last updated Dec 2, 2014
Key facts
- NPI
- 1609877489
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- CMD06972 (RI)
- Practice address
- 1053 S Broadway
East Providence, RI 02914-4729 - Phone
- (401) 438-5551
- Fax
- (401) 438-7272
- NPI assigned
- Aug 3, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 1983
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
1053 S Broadway
East Providence, RI 02914-4729
Phone (401) 438-5551
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in RI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040212000637 | RI | Practitioner - Family Practice | 4981509619 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CMD06972 | RI | MD | Family Medicine Physician |
| G7396 | TX | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Armistice Urgent Care & Occupational Health, Inc. | Family Medicine | Past | Accepting new patients |
| Memorial Hospital | Family Medicine | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | CMD06972 | RI | Yes |
| Family Medicine Physician | 207Q00000X | G7396 | TX | |
| Family Medicine Physician | 207Q00000X | 150111 | MA |
Addresses
Primary practice location
1053 S Broadway
East Providence, RI 02914-4729
Mailing address
1053 S Broadway
East Providence, RI 02914-4729
Phone (401) 438-5551
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2047248 | Other | RI | HEALTH CARE VALUE MGMT |
| 26953 | Other | RI | BLUE CROSS BLUE SHIELD |
| 9374902 | Other | RI | PHCS |
| 0103881 | Other | RI | UNITED HEALTH CARE |
| 200861 | Other | RI | BLUE CHIP (BCBSRI) |
| 2047248 | Other | RI | CCN |
| 12287833 | Other | RI | MULTIPLAN |
| 2047248 | Other | RI | FIRST HEALTH |
Other providers in East Providence, RI
- Julie Elizabeth Braciszewski
- Brain Injury Association of Rhode Island
- Emily Branch
- Elizabeth Branconnier
- Sarah Brandwood
- Charles John Brex
- Geana Brillon
- Shanan T Brissette
- Broadway Medical Treatment Center, LLC
- Amanda Brogna
All providers in East Providence, RI · Family Medicine Physician in Rhode Island
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 2, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.