Individual provider Active NPI

Rachael Erin Prendergast, MSN, RN, PNP-AC

  • Pediatric Nurse Practitioner
  • Providence, RI
National Provider Identifier
1700393394
Registry record updated Aug 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
APRN04116 Issued in RI
Practice address
593 Eddy St
Providence, RI 02903-4923
Phone
(401) 444-7396
NPI assigned
Jan 4, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2024

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 SP018433 PA
Pediatric Nurse Practitioner 363LP0200X RN2288750 MA
Pediatric Nurse Practitioner 363LP0200X APRN04116 RI Primary

Addresses

Primary practice location

593 Eddy St
Providence, RI 02903-4923

Mailing address

117 Ellenfield St Ste 101
Providence, RI 02905-4541
Phone (401) 444-6779

Other practice location 1

3401 Civic Center Blvd
Philadelphia, PA 19104-4319
Phone (215) 590-1000

Other practice location 2

300 Longwood Ave
Boston, MA 02115-5724
Phone (617) 355-6000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, RI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20211005001095 PA Practitioner - Nurse Practitioner 1456759513 Reassigns benefits to 1 organization
I20241024001286 RI Practitioner - Nurse Practitioner 1456759513 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Registered Nurse

State licenses

LicenseStateTypeSpecialty
SP018433PAMDPediatrics Physician
RN2288750MAMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Childrens Health Care Associates CurrentSince Jun 26, 2021 Accepting new patients
Rhode Island Hospital CurrentSince Aug 17, 2024 Accepting new patients
Childrens Health Care Associates, Inc Pediatrics Current Accepting new patients
Rhode Island Hospital Pediatrics CurrentSince Aug 17, 2024 Accepting new patients
Childen'S Health Care Associates Inc. CurrentSince Jun 26, 2021 Accepting new patients

Locations

3401 Civic Center Blvd
Philadelphia, PA 19104
Phone (215) 590-4040

1454 S County Trl
Ste 2100
East Greenwich, RI 02818
Phone (401) 606-2000

593 Eddy St
Ste 5
Providence, RI 02903
Phone (401) 444-3996

593 Eddy St
Lowr
Providence, RI 02903
Phone (401) 444-4471

593 Eddy St
Providence, RI 02903

117 Ellenfield St
Ste 101
Providence, RI 02905
Phone (401) 444-4318

Interoperability endpoints

  • Direct secure messaging: rprendergast38057@direct.bostonchildrens.org

Organizations & group practices 5

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": "1515024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722988800000",
    "number": "1700393394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 ELLENFIELD ST STE 101",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029054541",
            "telephone_number": "401-444-6779"
        },
        {
            "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": "401-444-7396"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3401 Civic Center Blvd",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191044319",
            "country_code": "US",
            "telephone_number": "215-590-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "300 Longwood Ave",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021155724",
            "country_code": "US",
            "telephone_number": "617-355-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PRENDERGAST",
        "first_name": "RACHAEL",
        "middle_name": "ERIN",
        "credential": "MSN, RN, PNP-AC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-04",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "SP018433",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MA",
            "license": "RN2288750",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "RI",
            "license": "APRN04116",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.