Individual provider Active NPI

David E Wazer, M.D

  • Radiation Oncology Physician
  • Providence, RI
National Provider Identifier
1821053653
Registry record updated Apr 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
MD09674 Issued in RI
Practice address
593 Eddy St
Department of Radiation Oncology
Providence, RI 02903-4923
Phone
(401) 444-8311
Fax
(401) 444-5335
NPI assigned
Apr 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X 00-59408 MA
Radiation Oncology Physician 2085R0001X MD09674 RI Primary

Addresses

Primary practice location

593 Eddy St
Department of Radiation Oncology
Providence, RI 02903-4923

Mailing address

593 Eddy St
Department of Radiation Oncology
Providence, RI 02903-4923
Phone (401) 444-8311

Other identifiers 7

IdentifierTypeStateIssuer
4804-8OtherRIBLUE CROSS BLUE SHIELD
7006674MedicaidRI
709180OtherMATUFTS HEALTH PLAN
2400030OtherRIUNITED HEALTHCARE
P00762784OtherRIRAILROAD MEDICARE - RADIOSURGERY CENTER OF RI
3032477MedicaidMA
0190162OtherRICIGNA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, RI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20050405001044 MA Practitioner - Radiation Oncology 3072580570 Reassigns benefits to 2 organizations
I20070716000589 RI Practitioner - Radiation OncologyPractitioner - Hematology/Oncology 3072580570 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
New York University School of Medicine, 1982
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) 444-8311

Hospital & facility affiliations

  • Rhode Island Hospital Hospital, Providence, RI, CCN 410007

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
00-59408MAMDRadiation Oncology Physician
MD09674RIMDRadiation Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pratt Radiation Oncology Associates Inc Radiation Oncology CurrentSince May 4, 1988 Accepting new patients
Lifespan Physician Group, Inc. CurrentSince Apr 1, 2024 Accepting new patients
Rhode Island Hospital CurrentSince Apr 1, 2024 Accepting new patients
Lifespan Corporation Current Accepting new patients
Lifespan Physician Group, Inc. CurrentSince Apr 1, 2024 Accepting new patients
Radiosurgery Center of Rhode Island LLC Radiation Oncology CurrentSince Nov 4, 2010 Accepting new patients
Rhode Island Hospital CurrentSince Apr 1, 2024 Accepting new patients
Lifespan Physician Group, Inc. Past Accepting new patients
Women & Infants Hospital of Rhode Island Past Accepting new patients

Locations

800 Washington St
#1013
Boston, MA 02111
Phone (617) 636-0491

800 Washington St
Boston, MA 02111
Phone (617) 636-4800

750 Washington St
Boston, MA 02111
Phone (617) 636-4600

795 Middle St
Fall River, MA 02721
Phone (508) 235-5046

1454 S County Trl
Ste 2100
East Greenwich, RI 02818
Phone (401) 606-2000

185A High Service Ave
North Providence, RI 02904
Phone (401) 354-6050

593 Eddy St
Providence, RI 02903

593 Eddy St
Bsmt Apc
Providence, RI 02903
Phone (401) 444-8311

101 Dudley St
Fl 3
Providence, RI 02905
Phone (401) 351-5297

345 Blackstone Blvd
Providence, RI 02906
Phone (401) 455-6375

164 Summit Ave
Providence, RI 02906
Phone (401) 793-2104

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

Interoperability endpoints

  • Direct secure messaging: dwazer15143@brownhealth.medalliesdirect.net

Organizations & group practices 10

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 4

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": "1145232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713484800000",
    "number": "1821053653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "593 EDDY ST",
            "address_2": "DEPARTMENT OF RADIATION ONCOLOGY",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034923",
            "telephone_number": "401-444-8311",
            "fax_number": "401-444-5335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "593 EDDY ST",
            "address_2": "DEPARTMENT OF RADIATION ONCOLOGY",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034923",
            "telephone_number": "401-444-8311",
            "fax_number": "401-444-5335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAZER",
        "first_name": "DAVID",
        "middle_name": "E",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-17",
        "last_updated": "2024-04-19",
        "certification_date": "2024-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "MA",
            "license": "00-59408",
            "primary": false
        },
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "RI",
            "license": "MD09674",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "4804-8",
            "state": "RI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7006674",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS HEALTH PLAN",
            "identifier": "709180",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "2400030",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE - RADIOSURGERY CENTER OF RI",
            "identifier": "P00762784",
            "state": "RI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3032477",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "0190162",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.