NPIMap

Individual provider Active NPI

John A Stoukides, MD

  • Geriatric Medicine (Family Medicine) Physician
  • East Providence, RI
National Provider Identifier
1639176357
Registry record updated Jan 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
License
MD07851 Issued in RI
Practice address
1018 Waterman Ave
East Providence, RI 02914
Phone
(401) 231-0450
Fax
(401) 233-2387
NPI assigned
Jul 7, 2005
Last updated
Jan 15, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) Physician 207QG0300X MD07851 RI Primary

Addresses

Primary practice location

1018 Waterman Ave
East Providence, RI 02914

Mailing address

1018 Waterman Ave
East Providence, RI 02914
Phone (401) 231-0450

Other identifiers 1

IdentifierTypeStateIssuer
7001413MedicaidRI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050405000071 RI Practitioner - Geriatric MedicinePractitioner - Internal MedicinePractitioner - Other (Physician) 2961454053 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Geriatric MedicineAlso: Internal Medicine
Education
Tufts University School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Prospect Chartercare RWMC, LLCGroup PAC ID 0547492696, 66 clinicians

Practice addresses (Care Compare)

700 Smith St
North Providence, RI 02908-3500
Phone (401) 621-6464

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD07851RIMDGeriatric Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prospect Chartercare RWMC, LLC CurrentSince Jun 1, 2014 Accepting new patients
Prospect Chartercare RWMC, LLC CurrentSince Jun 1, 2014 Accepting new patients
Chartercare Roger Williams Medical Center CurrentSince Aug 1, 2025 Accepting new patients

Locations

1018 Waterman Ave
East Providence, RI 02914
Phone (401) 231-0450

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

Interoperability endpoints

  • Direct secure messaging: jstoukid@direct.chartercare.org

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Tri-Town Health CenterJohnston, RI, CCN 411812 Federally qualified health center Corporate Director Nov 1, 2022

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547510400000",
    "number": "1639176357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1018 WATERMAN AVE",
            "city": "EAST PROVIDENCE",
            "state": "RI",
            "postal_code": "02914",
            "telephone_number": "401-231-0450",
            "fax_number": "401-233-2387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1018 WATERMAN AVE",
            "city": "EAST PROVIDENCE",
            "state": "RI",
            "postal_code": "02914",
            "telephone_number": "401-231-0450",
            "fax_number": "401-233-2387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOUKIDES",
        "first_name": "JOHN",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2019-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "RI",
            "license": "MD07851",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7001413",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Providence, RI

Sources for this page

Verify at the official NPI Registry.