Roger Niles Mennillo, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD09221 Issued in RI

Practice address

176 Toll Gate Rd
Suite 101
Warwick, RI 02886-4482

Phone

(401) 737-9270

Fax

(401) 739-6413

NPI assigned

Feb 23, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rmennillo220864@brownhealth.medalliesdirect.net
• Direct secure messaging: rmennillo@wih.cernerdirect.carene.org

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.

• Coastal Medical Physicians, Inc.

  • Internal Medicine Physician
  • Riverside, RI
  • NPI 1093678104
  NPD
• Coastal Medical Physicians, Inc.

  • Internal Medicine Physician
  • Providence, RI
  • NPI 1780273540

  Pediatrics

  NPD
• Lifespan Corporation

  • Children's Rehabilitation Hospital
  • Providence, RI
  • NPI 1790221232
  NPD

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

{
    "created_epoch": "1140652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712188800000",
    "number": "1730155482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 DAVOL SQ",
            "address_2": "SUITE 400",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034754",
            "telephone_number": "401-421-4000",
            "fax_number": "401-272-1456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "176 TOLL GATE RD",
            "address_2": "SUITE 101",
            "city": "WARWICK",
            "state": "RI",
            "postal_code": "028864482",
            "telephone_number": "401-737-9270",
            "fax_number": "401-739-6413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENNILLO",
        "first_name": "ROGER",
        "middle_name": "NILES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-23",
        "last_updated": "2024-04-04",
        "certification_date": "2024-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "RI",
            "license": "MD09221",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RM51805",
            "state": "RI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rmennillo220864@direct.lifespan.org",
            "affiliation": "N",
            "address_1": "176 Toll Gate Rd",
            "address_2": "Suite 101",
            "city": "Warwick",
            "state": "RI",
            "country_code": "US",
            "postal_code": "028864482",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ashleigh Mendelowitz Calcote, DO
• Dalanee Lemice Mendes
• Rudilania Mendez
• Stephanie Menges, MPAS, PA-C
• Haran Asher Mennillo, MD
• Allison Menton, M.A, BCBA, LBA
• Alisa J Merolli, M.D.
• Allyson Messier, MS, CCC-SLP
• Martin Metzger, DDS
• Barbara Irene Mey, LMHC

• Pediatrics Physician in Warwick, RI
• Providers in Warwick, RI by specialty
• Pediatrics Physician in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2024; 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.

Verify at the official NPI Registry.