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Bayside Endoscopy Center, LLC

Organization Active NPI Endoscopy Clinic/Center · Providence, RI

NPI 1720085657 · NPPES record last updated Feb 8, 2023

Key facts

NPI
1720085657
Entity type
Organization (NPI type 2)
Primary specialty
Endoscopy Clinic/Center 261QE0800X
License
FAS01011 (RI)
Legal business name
BAYSIDE ENDOSCOPY CENTER, LLC
Practice address
33 Staniford St
Providence, RI 02905-3105
Phone
(401) 274-1810
Fax
(401) 273-9689
NPI assigned
Jul 7, 2005
Organization subpart
No

Authorized official

Name
Jennifer Boyd Baldock
Title
Officer and Authorized Official
Phone
(615) 234-5954

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare Care Compare: Ambulatory surgical center

Listed as
Bayside Endoscopy LLC CCN 41C0001003
Medicare certification status
Active (Provider of Services file)

Source: Medicare Care Compare.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
41D0907255Bayside Endoscopy Center Inc
33 Staniford Street First Floor, Providence, RI 02905		Certificate of waiverDec 7, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in RI

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040616000007 RI Part B Supplier - Ambulatory Surgical Center 8224012463 Practice locations: Providence, RI

National Provider Directory

Tax ID family
Bayside Endoscopy Center LLC (3 organizations share this tax ID)

Locations

33 Staniford St
#1
Providence, RI 02905
Phone (401) 649-4229

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Endoscopy Clinic/Center 261QE0800X FAS01011 RI Yes

Addresses

Primary practice location

33 Staniford St
Providence, RI 02905-3105

Mailing address

33 Staniford St
Providence, RI 02905-3105
Phone (401) 274-1810

Other identifiers

IdentifierTypeStateIssuer
9411003MedicaidRI

Other names

  • BAYSIDE ENDOSCOPY CENTER Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 8, 2023.

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675814400000",
    "number": "1720085657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 STANIFORD ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029053105",
            "telephone_number": "401-274-1810",
            "fax_number": "401-273-9689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 STANIFORD ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029053105",
            "telephone_number": "401-274-1810",
            "fax_number": "401-273-9689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAYSIDE ENDOSCOPY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-07",
        "last_updated": "2023-02-08",
        "certification_date": "2023-02-08",
        "status": "A",
        "authorized_official_last_name": "BALDOCK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "BOYD",
        "authorized_official_title_or_position": "OFFICER AND AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "615-234-5954"
    },
    "taxonomies": [
        {
            "code": "261QE0800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Endoscopy",
            "state": "RI",
            "license": "FAS01011",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9411003",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BAYSIDE ENDOSCOPY CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Providence, RI

All providers in Providence, RI · Endoscopy Clinic/Center in Rhode Island

Sources for this page

Verify at the official NPI Registry.