NPIMap

Organization Active NPI

Meditelecare of Rhode Island LLC

  • Nurse Practitioner
  • Warwick, RI
National Provider Identifier
1801477963
Registry record updated May 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
MEDITELECARE OF RHODE ISLAND LLC
Practice address
222 Jefferson Blvd Ste 200
Warwick, RI 02888-3855
Phone
(860) 788-6404
NPI assigned
Apr 19, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2025

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

Authorized official

Name
Andrea Godfrey
Title
Credentialing & Enrollment Manager
Phone
(860) 398-6441

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical NeuropsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103G00000X
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

222 Jefferson Blvd Ste 200
Warwick, RI 02888-3855

Mailing address

PO Box 1595
Middletown, CT 06457-8095
Phone (860) 788-6404

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210506001621 RI Part B Supplier - Clinic/Group Practice 4385053131 Receives reassigned benefits from 14 practitioners
Practice locations: Warwick, RI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1618790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746403200000",
    "number": "1801477963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1595",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064578095",
            "telephone_number": "860-788-6404",
            "fax_number": "860-829-0495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 JEFFERSON BLVD STE 200",
            "city": "WARWICK",
            "state": "RI",
            "postal_code": "028883855",
            "telephone_number": "860-788-6404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDITELECARE OF RHODE ISLAND LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-19",
        "last_updated": "2025-05-05",
        "certification_date": "2025-05-05",
        "status": "A",
        "authorized_official_last_name": "GODFREY",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "CREDENTIALING & ENROLLMENT MANAGER",
        "authorized_official_telephone_number": "860-398-6441"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warwick, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.