Individual provider Active NPI

John Alan Sisti, O.D.

  • Optometrist
  • Warwick, RI
National Provider Identifier
1679603096
Registry record updated Mar 24, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC3173 Issued in FL
Practice address
566 Toll Gate Rd
Warwick, RI 02886-2716
Phone
(401) 738-4800
NPI assigned
Mar 6, 2007
Last updated
Mar 24, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2010

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPC3173 FL Primary
Optometrist 152W00000X 002443 CT
Optometrist 152W00000X 4007 MA
Optometrist 152W00000X ODTA00541 RI

Addresses

Primary practice location

566 Toll Gate Rd
Warwick, RI 02886-2716

Mailing address

566 Toll Gate Rd
Warwick, RI 02886-2716
Phone (401) 738-4800

Other identifiers 5

IdentifierTypeStateIssuer
52201OtherDAVIS VISION
20838OtherBLUECROSSBLUESHIELD
29241OtherSPECTERA,UNITEDHEALTHCARE
620358200MedicaidFL
JS73492MedicaidRI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
002443CTMDOptometrist
OPC3173FLMDOptometrist
ODTA00541RIMDOptometrist
4007MAMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Alan J Knapp MD PA PastSince Sep 12, 2005 Accepting new patients
Edward Fetherolf M D P a Past Accepting new patients
Eye Centers of Florida Optometrist Past Accepting new patients
Eye Centers of Florida Optometrist Past Accepting new patients

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269388800000",
    "number": "1679603096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "566 TOLL GATE RD",
            "city": "WARWICK",
            "state": "RI",
            "postal_code": "028862716",
            "telephone_number": "401-738-4800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "566 TOLL GATE RD",
            "city": "WARWICK",
            "state": "RI",
            "postal_code": "028862716",
            "telephone_number": "401-738-4800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SISTI",
        "first_name": "JOHN",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-06",
        "last_updated": "2010-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC3173",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CT",
            "license": "002443",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "4007",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "RI",
            "license": "ODTA00541",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DAVIS VISION",
            "identifier": "52201",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSSBLUESHIELD",
            "identifier": "20838",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPECTERA,UNITEDHEALTHCARE",
            "identifier": "29241",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "620358200",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "JS73492",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Warwick, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.