NPIMap

Individual provider Active NPI

Peter Joseph Mazzaglia, MD

  • Surgery Physician
  • Providence, RI
National Provider Identifier
1639103617
Registry record updated Jan 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
MD12186 Issued in RI
Practice address
2 Dudley St
Suite 470
Providence, RI 02905-3236
Phone
(401) 223-0962
Fax
(401) 861-1272
NPI assigned
Jul 10, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X MD12186 RI Primary

Addresses

Primary practice location

2 Dudley St
Suite 470
Providence, RI 02905-3236

Mailing address

PO Box 16149
Rumford, RI 02916-0697
Phone (401) 453-9625

Other identifiers 2

IdentifierTypeStateIssuer
31703-4OtherRIRHODE ISLAND BCBS
7058687MedicaidRI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Peter.Mazzaglia.usasurg@direct-address.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI, MA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20061009000025 RI Practitioner - General Surgery 5496799397 Reassigns benefits to 2 organizations
I20260130000928 MA Practitioner - General Surgery 5496799397 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Massachusetts Medical School, 1993
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Lifespan Physician Group IncGroup PAC ID 2567455082, 1,151 clinicians
University Surgical Associates, Inc.Group PAC ID 4082503032, 105 clinicians
Lifespan Physician Group of Massachusetts IncGroup PAC ID 3870020399, 458 clinicians

Practice addresses (Care Compare)

2 Dudley St
Suite 470
Providence, RI 02905-3248
Phone (401) 272-1800

531 Faunce Corner Rd
Dartmouth, MA 02747-1242
Phone (508) 996-3991

535 Faunce Corner Rd
Dartmouth, MA 02747-1242
Phone (508) 996-3991

537 Faunce Corner Rd
Dartmouth, MA 02747-1242
Phone (508) 996-3991

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1021688MAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Lifespan Physician Group of Massachusetts Inc Surgery CurrentSince Dec 1, 2025 Accepting new patients
University Surgical Associates, Inc. Surgery CurrentSince Aug 7, 2006 Accepting new patients
Rhode Island Hospital Current Accepting new patients
Lifespan Physician Group, Inc. CurrentSince Dec 1, 2025 Accepting new patients
Lifespan Physician Group, Inc. Surgery CurrentSince Dec 1, 2025 Accepting new patients
Lifespan Physician Group, Inc. Past Accepting new patients

Locations

851 Middle St
Ste 3200
Fall River, MA 02721
Phone (508) 235-5277

531 Faunce Corner Rd
North Dartmouth, MA 02747
Phone (508) 991-2255

1407 S County Trl
Ste 423
East Greenwich, RI 02818
Phone (401) 228-0590

185A High Service Ave
North Providence, RI 02904
Phone (401) 354-6050

154 Waterman St
Ste 2
Providence, RI 02906
Phone (401) 223-0962

2 Dudley St
Ste 470
Providence, RI 02905
Phone (401) 274-7546

639 Metacom Ave
Warren, RI 02885
Phone (401) 245-1500

Interoperability endpoints

  • Direct secure messaging: peter.mazzaglia.usasurg@direct-address.net

Organizations & group practices 6

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 8

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": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580256000000",
    "number": "1639103617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 16149",
            "city": "RUMFORD",
            "state": "RI",
            "postal_code": "029160697",
            "telephone_number": "401-453-9625",
            "fax_number": "401-435-7069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 DUDLEY ST",
            "address_2": "SUITE 470",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029053236",
            "telephone_number": "401-223-0962",
            "fax_number": "401-861-1272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZZAGLIA",
        "first_name": "PETER",
        "middle_name": "JOSEPH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2020-01-29",
        "certification_date": "2020-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "RI",
            "license": "MD12186",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RHODE ISLAND BCBS",
            "identifier": "31703-4",
            "state": "RI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7058687",
            "state": "RI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Peter.Mazzaglia.usasurg@direct-address.net",
            "affiliation": "N",
            "endpointDescription": "Direct",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2 Dudley St",
            "address_2": "Suite 470",
            "city": "Providence",
            "state": "RI",
            "country_code": "US",
            "postal_code": "029053236",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.