Individual provider Active NPI

Sonia C Peck, PHYSICIAN ASSISTANT

  • Medical Physician Assistant
  • Providence, RI
National Provider Identifier
1639477433
Registry record updated Mar 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA00224 Issued in RI
Practice address
164 Summit Ave
Providence, RI 02906-2853
Phone
(401) 793-3570
NPI assigned
Mar 3, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA00224 RI Primary

Addresses

Primary practice location

164 Summit Ave
Providence, RI 02906-2853

Mailing address

164 Summit Avenue
Providence, RI 02906
Phone (401) 793-3570

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130620000280 MA Practitioner - Physician Assistant 4385883412 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physicians of Cape Cod HospitalGroup PAC ID 9638326671, 330 clinicians

Practice addresses (Care Compare)

27 Park St
Hyannis, MA 02601-5230
Phone (774) 552-6000

60 A Park St
Hyannis, MA 02601-5231
Phone (774) 552-6050

Hospital & facility affiliations

  • Cape Cod Hospital Hospital, Hyannis, MA, CCN 220012
  • Falmouth Hospital Hospital, Falmouth, MA, CCN 220135

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA00224RIMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Southcoast Physicians Group, Inc. CurrentSince May 1, 2013 Accepting new patients
Southcoast Physicians Group, Inc. Past Accepting new patients

Locations

534 Prospect St
Fall River, MA 02720
Phone (508) 679-7766

363 Highland Ave
Fall River, MA 02720
Phone (508) 679-7052

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 and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1299110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1299110400000",
    "number": "1639477433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "164 SUMMIT AVENUE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "02906",
            "telephone_number": "401-793-3570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "164 SUMMIT AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029062853",
            "telephone_number": "401-793-3570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PECK",
        "first_name": "SONIA",
        "middle_name": "C",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-03",
        "last_updated": "2011-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "RI",
            "license": "PA00224",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.