Individual provider Active NPI

Roger F Fazio, M.D.

  • Pediatric Adolescent Medicine Physician
  • Wakefield, RI
National Provider Identifier
1760448930
Registry record updated Jul 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
License
MD11861 Issued in RI
Practice address
49 S County Commons Way Unit F5
Wakefield, RI 02879-8200
Phone
(401) 783-8008
Fax
(401) 783-8156
NPI assigned
Apr 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine Physician 2080A0000X MD11861 RI Primary

Addresses

Primary practice location

49 S County Commons Way Unit F5
Wakefield, RI 02879-8200

Mailing address

49 S County Commons Way Unit F5
Wakefield, RI 02879-8200
Phone (401) 783-8008

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: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050908001231 RI Practitioner - Pediatric Medicine 1557393691 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD11861RIMDPediatric Adolescent Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Affinity Physicians LLC. CurrentSince Aug 17, 2025 Accepting new patients
Silver Spring Health Care Management, Inc. Adolescent Medicine CurrentSince Jan 1, 2014 Accepting new patients
Silver Spring Health Care Management, Inc. CurrentSince Jan 1, 2014 Accepting new patients
Osteopathic Family Medicine, LLC Past Accepting new patients

Locations

101 Dudley St
Ofc
Providence, RI 02905

70 Kenyon Ave
Unit 211
Wakefield, RI 02879
Phone (401) 789-8543

100 Kenyon Ave
Wakefield, RI 02879
Phone (401) 782-8000

49 South County Commons Way
Unit F5
Wakefield, RI 02879
Phone (401) 783-8008

455 Toll Gate Rd
Warwick, RI 02886
Phone (401) 737-7000

Interoperability endpoints

  • Direct secure messaging: rfazio11060@direct.carene.org

Organizations & group practices 4

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": "1145923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753401600000",
    "number": "1760448930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49 S COUNTY COMMONS WAY UNIT F5",
            "city": "WAKEFIELD",
            "state": "RI",
            "postal_code": "028798200",
            "telephone_number": "401-783-8008",
            "fax_number": "401-783-8156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 S COUNTY COMMONS WAY UNIT F5",
            "city": "WAKEFIELD",
            "state": "RI",
            "postal_code": "028798200",
            "telephone_number": "401-783-8008",
            "fax_number": "401-783-8156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAZIO",
        "first_name": "ROGER",
        "middle_name": "F",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-25",
        "last_updated": "2025-07-25",
        "certification_date": "2025-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "RI",
            "license": "MD11861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wakefield, RI

Sources for this page

Verify at the official NPI Registry.