Mimi Rosealie Borrelli

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

LP05003 Issued in RI

Practice address

593 Eddy St
Providence, RI 02903-4923

Phone

(650) 283-8746

NPI assigned

Jun 3, 2020

Last updated

Jun 3, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1591142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591142400000",
    "number": "1649894924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "593 EDDY ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034923",
            "telephone_number": "650-283-8746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "593 EDDY ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034923",
            "telephone_number": "650-283-8746"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "25 Holden St Unit 2201",
            "address_purpose": "LOCATION",
            "city": "Providence",
            "state": "RI",
            "postal_code": "029085792",
            "country_code": "US",
            "telephone_number": "650-283-8746",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BORRELLI",
        "first_name": "MIMI",
        "middle_name": "ROSEALIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-06-03",
        "last_updated": "2020-06-03",
        "certification_date": "2020-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "RI",
            "license": "LP05003",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "LP05003",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GREEN CARD",
            "identifier": "219-177-128",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Suzanne Bornschein, MD
• Erik Borodemos, MSN, APRN, PMHNP-BC
• Joanne Borodemos, RN
• Christine Linda Borowy, PHARM.D
• Debra Borrelli
• Brian Borsari, PHD
• William Bortcosh, M.D.
• Jillian Borzain, OTR/L
• Lewis J Bosler, MA - COUNSELING PSYC
• Michael Anthony Bossi, LCSW

• Plastic Surgery Physician in Providence, RI
• Providers in Providence, RI by specialty
• Plastic Surgery Physician in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.