Active NPI
Robert Dattilo, DPT
- Physical Therapist
- Pawtucket, RI
National Provider Identifier
1790200350
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT03012
- Practice address
- 21 Division St
Pawtucket, RI 02860-5301 - Phone
- (401) 726-7100
- Fax
- (401) 721-5214
- NPI assigned
- Aug 4, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT03012 | RI | Primary |
Addresses
Primary practice location
21 Division St
Pawtucket, RI 02860-5301
Mailing address
4 Richmond SQ Ste 200
Providence, RI 02906-5117
Phone (401) 433-4172
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in RI
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
21 Division St
Pawtucket, RI 02860-5301
Phone (401) 726-7100
Merit-based Incentive Payment System (MIPS)
- Final score
- 80.9 of 100
- Quality
- 79.21
- Improvement activities
- 40
- Cost
- 74.46
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT03012 | RI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Silver Fern Practice, LLC | Physical Therapist | Current | Accepting new patients |
| Silver Fern Practice, LLC | Physical Therapist | Current | Accepting new patients |
Locations
21 Division St
Pawtucket, RI 02860
4 Richmond Sq
Ste 200
Providence, RI 02906
41 Sanderson Rd
Ste 101
Smithfield, RI 02917
Phone (401) 349-4540
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": "1501804800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1514246400000",
"number": "1790200350",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4 RICHMOND SQ STE 200",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029065117",
"telephone_number": "401-433-4172",
"fax_number": "401-433-0612"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21 DIVISION ST",
"city": "PAWTUCKET",
"state": "RI",
"postal_code": "028605301",
"telephone_number": "401-726-7100",
"fax_number": "401-721-5214"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DATTILO",
"first_name": "ROBERT",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-08-04",
"last_updated": "2017-12-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "RI",
"license": "PT03012",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pawtucket, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.