Charlie Imonah, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

NPP37898 Issued in RI

Practice address

39 East Ave
Pawtucket, RI 02860-4003

Phone

(401) 722-0081

Fax

(401) 312-0318

NPI assigned

Aug 15, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in RI

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

Specialty

Nurse Practitioner

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Blackstone Valley Community Health Care IncGroup PAC ID 8628045762, 49 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• The Miriam Hospital Hospital, Providence, RI, CCN 410012

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: charlie.imonah.p1@direct.bvchc.nextgenshare.com

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.

• Blackstone Valley Community Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Pawtucket, RI
  • NPI 1063574135
  Medicare reassignment Care Compare group NPD
• Blackstone Valley Community Health Care, Inc.

  • Federally Qualified Health Center (FQHC)
  • Central Falls, RI
  • NPI 1275847766
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• The Miriam Hospital

  • General Acute Care Hospital
  • Providence, RI
  • NPI 1487649430
  Care Compare affiliation

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

{
    "created_epoch": "1408060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417824000000",
    "number": "1659770642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 EAST AVE",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028604003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 EAST AVE",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028604003",
            "telephone_number": "401-722-0081",
            "fax_number": "401-312-0318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IMONAH",
        "first_name": "CHARLIE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-15",
        "last_updated": "2014-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "RI",
            "license": "NPP37898",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Albert D Iannotti Jr., LCSW
• Shawna Iannotti, MASTERS
• Karen J Iannucci, RNP
• Sadia Iftikhar, MD
• Taye Tope Ikotun Sr.
• Independent Care LLC
• Inner Cosmos Perinatal Services LLC
• Inner Journeys Psychotherapy LLC
• Integrated Psychological Services
• Michael Iozzo, BACHELORS

• Family Nurse Practitioner in Pawtucket, RI
• Providers in Pawtucket, RI by specialty
• Family Nurse Practitioner in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2014; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.