Individual provider Active NPI

Holly Amber Gentile, PA-C

  • Physician Assistant
  • Providence, RI
National Provider Identifier
1760978183
Registry record updated Mar 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA01033 Issued in RI
Practice address
345 Blackstone Blvd
Providence, RI 02906-4800
Phone
(203) 240-5871
NPI assigned
Jul 9, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA01033 RI Primary

Addresses

Primary practice location

345 Blackstone Blvd
Providence, RI 02906-4800

Mailing address

345 Blackstone Blvd Ste 2
Providence, RI 02906-4829
Phone (401) 455-6356

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180815002888 RI Practitioner - Physician Assistant 6103175757 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA01033RIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Affinity Physicians LLC CurrentSince Sep 1, 2018 Accepting new patients

Locations

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

Interoperability endpoints

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

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1531094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616112000000",
    "number": "1760978183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 BLACKSTONE BLVD STE 2",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029064829",
            "telephone_number": "401-455-6356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 BLACKSTONE BLVD",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029064800",
            "telephone_number": "203-240-5871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GENTILE",
        "first_name": "HOLLY",
        "middle_name": "AMBER",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-09",
        "last_updated": "2021-03-19",
        "certification_date": "2021-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "RI",
            "license": "PA01033",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.