NPIMap

Organization Active NPI

Bayside Endoscopy Center, LLC

Doing business as Bayside Endoscopy Center

  • Endoscopy Clinic/Center
  • Providence, RI
National Provider Identifier
1720085657
Registry record updated Feb 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endoscopy Clinic/CenterTaxonomy code 261QE0800X
License
FAS01011 Issued in RI
Legal business name
BAYSIDE ENDOSCOPY CENTER, LLC
Doing business as
Bayside Endoscopy Center
Practice address
33 Staniford St
Providence, RI 02905-3105
Phone
(401) 274-1810
Fax
(401) 273-9689
NPI assigned
Jul 7, 2005
Last updated
Feb 8, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2023

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

Authorized official

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

Specialties & licenses 1

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

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 names 1

  • BAYSIDE ENDOSCOPY CENTER Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI

Enrollment records 1

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

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Bayside Endoscopy LLCCCN 41C0001003
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
41D0907255Bayside Endoscopy Center Inc33 Staniford Street First Floor, Providence, RI 02905Certificate of waiverDec 7, 2027

National Provider Directory

National Provider Directory
Tax ID family
Bayside Endoscopy Center LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

1637 Mineral Spring Ave
Ste 203
North Providence, RI 02904

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

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BAYSIDE ENDOSCOPY CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Feb 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.