Individual provider Active NPI

Sharon E Gibson, MD

  • Pediatric Otolaryngology Physician
  • Providence, RI
National Provider Identifier
1801904958
Registry record updated Aug 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Otolaryngology PhysicianTaxonomy code 207YP0228X
License
MD09174 Issued in RI
Practice address
130 Waterman St
Providence, RI 02906-2010
Phone
(401) 274-2300
Fax
(401) 272-1302
NPI assigned
Aug 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Otolaryngology Physician 207YP0228X MD09174 RI Primary

Addresses

Primary practice location

130 Waterman St
Providence, RI 02906-2010

Mailing address

118 Dudley St
Providence, RI 02905-2403
Phone (401) 274-2300

Other identifiers 1

IdentifierTypeStateIssuer
9020307MedicaidRI

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
I20040814000054 RI Practitioner - Otolaryngology 9436122843 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
University of Michigan Medical School, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Otolaryngology-Head and Neck Surgery, Inc.Group PAC ID 3274613930, 19 clinicians

Practice addresses (Care Compare)

830 Eddy St
Providence, RI 02905-4810
Phone (401) 885-8484

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University Otolaryngology-Head and Neck Surgery, Inc. CurrentSince Dec 1, 2007 Accepting new patients
University Otolaryngology Head & Neck Surgery Inc. PastSince Dec 1, 2007 Accepting new patients

Locations

1351 S County Trl
Ste 303
East Greenwich, RI 02818
Phone (401) 885-8484

1351 S County Trl
Ste 304
East Greenwich, RI 02818
Phone (401) 626-3708

118 Dudley St
Providence, RI 02905
Phone (401) 273-4155

830 Eddy St
Providence, RI 02905
Phone (401) 274-2300

130 Waterman St
Providence, RI 02906
Phone (401) 274-2300

Interoperability endpoints

  • Direct secure messaging: sgibson@univoto.emadirect.md

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": "1156723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407196800000",
    "number": "1801904958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 DUDLEY ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029052403",
            "telephone_number": "401-274-2300",
            "fax_number": "401-272-1302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 WATERMAN ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029062010",
            "telephone_number": "401-274-2300",
            "fax_number": "401-272-1302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "SHARON",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-28",
        "last_updated": "2014-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YP0228X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Pediatric Otolaryngology",
            "state": "RI",
            "license": "MD09174",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9020307",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.