Individual provider Active NPI

Laura Yvonne Mercurio, MD

  • Pediatric Emergency Medicine (Pediatrics) Physician
  • Providence, RI
National Provider Identifier
1699187492
Registry record updated Aug 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Emergency Medicine (Pediatrics) PhysicianTaxonomy code 2080P0204X
License
MD15750 Issued in RI
Practice address
593 Eddy St
Providence, RI 02903
Phone
(401) 444-4000
NPI assigned
May 28, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X LP03030 RI
Pediatrics Physician 208000000X MD15750 RI
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X MD15750 RI Primary

Addresses

Primary practice location

593 Eddy St
Providence, RI 02903

Mailing address

PO Box 9484
Providence, RI 02940-9484
Phone (401) 854-2500

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170525000266 RI Practitioner - Pediatric MedicinePractitioner - Emergency Medicine 6608093273 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
LP03030RIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lifespan Physician Group, Inc. CurrentSince Dec 1, 2020 Accepting new patients
Brown Emergency Medicine Pediatrics CurrentSince Jul 1, 2017 Accepting new patients
Lifespan Physician Group, Inc. Pediatrics CurrentSince Dec 1, 2020 Accepting new patients

Locations

185A High Service Ave
North Providence, RI 02904
Phone (401) 354-6050

593 Eddy St
Providence, RI 02903

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.

NPI Registry JSON

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

{
    "created_epoch": "1401235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534809600000",
    "number": "1699187492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9484",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029409484",
            "telephone_number": "401-854-2500",
            "fax_number": "401-854-2519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "593 EDDY ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "02903",
            "telephone_number": "401-444-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MERCURIO",
        "first_name": "LAURA",
        "middle_name": "YVONNE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-28",
        "last_updated": "2018-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "RI",
            "license": "LP03030",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "RI",
            "license": "MD15750",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "RI",
            "license": "MD15750",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.