Individual provider Active NPI

Mark Ryan Gauvin, MS, MSPAS, RD, PA-C

  • Physician Assistant
  • Providence, RI
National Provider Identifier
1801332507
Registry record updated Aug 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA01375 Issued in RI
Practice address
593 Eddy St
Providence, RI 02903-4923
Phone
(401) 444-4000
NPI assigned
Jan 18, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 4, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA01375 RI Primary
Registered Dietitian 133V00000X LDN00892 RI

Addresses

Primary practice location

593 Eddy St
Providence, RI 02903-4923

Mailing address

15 La Salle SQ
Providence, RI 02903-1814
Phone (401) 444-6779

Other practice location 1

200 High Service Ave
North Providence, RI 02904-5113
Phone (401) 456-3000

Other practice location 2

1360 W Main Rd
Middletown, RI 02842-6301
Phone (401) 606-3111

Other practice location 3

825 Chalkstone Ave
Providence, RI 02908-4728
Phone (401) 456-2000

Other identifiers 1

IdentifierTypeStateIssuer
110178471AOtherMAMASSHEALTH

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
I20211026001241 RI Practitioner - Physician Assistant 1850789728 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lifespan Physician Group IncGroup PAC ID 2567455082, 1,151 clinicians

Practice addresses (Care Compare)

593 Eddy St
Providence, RI 02903-4923
Phone (401) 444-7024

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Physician Assistant

State licenses

LicenseStateTypeSpecialty
LDN00892RIMDRegistered Dietitian
PA01375RIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Physician Associates of New England PC Physician Assistant CurrentSince May 9, 2026 Accepting new patients
Lifespan Physician Group, Inc. Physician Assistant CurrentSince Nov 7, 2021 Accepting new patients

Locations

1360 W Main Rd
Middletown, RI 02842
Phone (401) 606-3110

200 High Service Ave
North Providence, RI 02904
Phone (401) 456-3000

593 Eddy St
Providence, RI 02903

15 La Salle Sq
Providence, RI 02903

825 Chalkstone Ave
Providence, RI 02908
Phone (401) 456-2000

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

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 and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1484697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785801600000",
    "number": "1801332507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 LA SALLE SQ",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029031814",
            "telephone_number": "401-444-6779",
            "fax_number": "401-444-6912"
        },
        {
            "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": "401-444-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 High Service Ave",
            "address_purpose": "LOCATION",
            "city": "North Providence",
            "state": "RI",
            "postal_code": "029045113",
            "country_code": "US",
            "telephone_number": "401-456-3000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1360 W Main Rd",
            "address_purpose": "LOCATION",
            "city": "Middletown",
            "state": "RI",
            "postal_code": "028426301",
            "country_code": "US",
            "telephone_number": "401-606-3111",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "825 Chalkstone Ave",
            "address_purpose": "LOCATION",
            "city": "Providence",
            "state": "RI",
            "postal_code": "029084728",
            "country_code": "US",
            "telephone_number": "401-456-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GAUVIN",
        "first_name": "MARK",
        "middle_name": "RYAN",
        "name_prefix": "Mr.",
        "credential": "MS, MSPAS, RD, PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-01-18",
        "last_updated": "2026-08-04",
        "certification_date": "2026-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "RI",
            "license": "PA01375",
            "primary": true
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "RI",
            "license": "LDN00892",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MASSHEALTH",
            "identifier": "110178471A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.