Pieter Storm De Klerk, M.D
Individual provider Active NPI Interventional Cardiology Physician · Providence, RI
NPI 1730612490 · NPPES record last updated Apr 16, 2024
Key facts
- NPI
- 1730612490
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Interventional Cardiology Physician 207RI0011X
- License
- MD17152 (RI)
- Practice address
- 593 Eddy St
Providence, RI 02903-4923 - Phone
- (401) 444-5891
- Fax
- (401) 444-8158
- NPI assigned
- Apr 9, 2017
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 18
Hospital & facility affiliations 7
Medicare Care Compare profile
- Specialty
- Cardiovascular Disease (Cardiology)
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Lifespan Physician Group Inc
The Miriam Hospital
Practice addresses (Care Compare)
593 Eddy St
Providence, RI 02903-4923
Phone (401) 444-4000
950 Warren Ave
FL 2
East Providence, RI 02914-1432
Phone (401) 606-1004
Hospital & facility affiliations
- The Miriam Hospital
- Rhode Island Hospital
- Newport Hospital
- Sturdy Memorial Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Coronary angioplasty and stenting | 28 |
| Pacemaker insertion or repair | 1-10 |
| Leg revascularization (restoring blood flow) | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in RI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240610001304 | RI | Practitioner - Cardiovascular Disease (Cardiology) |
5597207258 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD17152 | RI | MD | Cardiovascular Disease Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lifespan Physician Group, Inc. | Current |
Accepting new patients | |
| Lifespan Physician Group, Inc. | Current |
Accepting new patients | |
| The Miriam Hospital | Current | Accepting new patients | |
| The Miriam Hospital | Current |
Accepting new patients | |
| The Miriam Hospital | Cardiovascular Disease | Current |
Accepting new patients |
| The Miriam Hospital | Current | Accepting new patients | |
| Lifespan Corporation | Current | Accepting new patients | |
| Lifespan Physician Group, Inc. | Past | Accepting new patients |
Locations
1454 S County Trl
Ste 2000
East Greenwich, RI 02818
Phone (401) 606-1100
950 Warren Ave
Fl 2
East Providence, RI 02914
950 Warren Ave
Ste 201
East Providence, RI 02914
Phone (855) 332-8474
185A High Service Ave
North Providence, RI 02904
Phone (401) 354-6050
164 Summit Ave
Providence, RI 02906
Phone (401) 793-2104
117 Ellenfield St
Ste 101
Providence, RI 02905
Phone (401) 444-4318
208 Collyer St
Ste 100
Providence, RI 02904
Phone (401) 793-7191
593 Eddy St
Providence, RI 02903
Interoperability endpoints
- pdeklerk192813@brownhealth.medalliesdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | MD17152 | RI | |
| Interventional Cardiology Physician | 207RI0011X | MD17152 | RI | Yes |
Addresses
Primary practice location
593 Eddy St
Providence, RI 02903-4923
Mailing address
117 Ellenfield St Ste 101
Providence, RI 02905-4541
NPI Registry JSON
{
"created_epoch": "1491696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1713225600000",
"number": "1730612490",
"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"
},
{
"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": "401-444-5891",
"fax_number": "401-444-8158"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DE KLERK",
"first_name": "PIETER",
"middle_name": "STORM",
"credential": "M.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-04-09",
"last_updated": "2024-04-16",
"certification_date": "2024-04-16",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "RI",
"license": "MD17152",
"primary": false
},
{
"code": "207RI0011X",
"taxonomy_group": "",
"desc": "Internal Medicine, Interventional Cardiology",
"state": "RI",
"license": "MD17152",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Providence, RI
- Aryanna Musme De Araujo E Sousa
- Mark Clayton De Binder Sr.
- Sara De Carvalho
- Paul A De Cesare
- Anne De Groot
- Ariana Q De Labry
- Jennifer De Leon
- Laura De Lima Xavier
- Renee J De Marco
- Catherine De Melas
All providers in Providence, RI · Interventional Cardiology Physician in Rhode Island
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 16, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.