Active NPI
Stephen T Mernoff, M.D.
- Neurology Physician
- Providence, RI
National Provider Identifier
1720045438
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 08403
- Practice address
- 877 Chalkstone Ave
Providence, RI 02908-4728 - Phone
- (401) 456-2310
- NPI assigned
- Apr 27, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 08403 | RI | Primary |
Addresses
Primary practice location
877 Chalkstone Ave
Providence, RI 02908-4728
Mailing address
50 Maude St
Providence, RI 02908-4325
Phone (401) 456-5368
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7003892 | Medicaid | RI |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160209002435 | RI | Order and Referring Only - Neurology | 8224076831 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 08403 | RI | MD | Neurology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720045438",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "50 MAUDE ST",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029084325",
"telephone_number": "401-456-5368",
"fax_number": "401-456-5782"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "877 CHALKSTONE AVE",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029084728",
"telephone_number": "401-456-2310"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MERNOFF",
"first_name": "STEPHEN",
"middle_name": "T",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "RI",
"license": "08403",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7003892",
"state": "RI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Providence, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.