Individual provider Active NPI

Sarah Peregrine, LICSW

  • Clinical Social Worker
  • Johnston, RI
National Provider Identifier
1750974549
Registry record updated Jul 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
ISW04023 Issued in RI
Practice address
1443 Hartford Ave
Johnston, RI 02919-3224
Phone
(401) 273-8100
Fax
(401) 861-8696
NPI assigned
Feb 12, 2021
Last updated
Jul 17, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 104167 CA
Clinical Social Worker 1041C0700X ISW04023 RI Primary

Addresses

Primary practice location

1443 Hartford Ave
Johnston, RI 02919-3224

Mailing address

117 Ellenfield St Ste 101
Providence, RI 02905-4541

Other practice location 1

600 A St Ste A
Davis, CA 95616-3648
Phone (530) 758-2060

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240813001032 RI Practitioner - Clinical Social Worker 5698101624 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gateway Healthcare IncGroup PAC ID 7719874908, 66 clinicians

Practice addresses (Care Compare)

101 -103 Bacon St
Pawtucket, RI 02860-5542
Phone (401) 722-3560

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
104167CAMDClinical Social Worker
ISW04023RIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Gateway Healthcare Inc CurrentSince Aug 26, 2024 Accepting new patients

Locations

1516 Atwood Ave
Johnston, RI 02919
Phone (401) 463-8829

105 Bacon St
Pawtucket, RI 02860
Phone (401) 722-3560

1 Virginia Ave
Ste 200
Providence, RI 02905

117 Ellenfield St
Ste 101
Providence, RI 02905
Phone (401) 444-4318

1443 Hartford Ave
Providence, RI 02919
Phone (401) 273-8100

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1613088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721174400000",
    "number": "1750974549",
    "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": "1443 HARTFORD AVE",
            "city": "JOHNSTON",
            "state": "RI",
            "postal_code": "029193224",
            "telephone_number": "401-273-8100",
            "fax_number": "401-861-8696"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 A St Ste A",
            "address_purpose": "LOCATION",
            "city": "Davis",
            "state": "CA",
            "postal_code": "956163648",
            "country_code": "US",
            "telephone_number": "530-758-2060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEREGRINE",
        "first_name": "SARAH",
        "credential": "LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-12",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "104167",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "RI",
            "license": "ISW04023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnston, RI

Sources for this page

Verify at the official NPI Registry.