Individual provider Active NPI

Nathaniel Ebbets White, MD

  • Pediatric Emergency Medicine (Pediatrics) Physician
  • Providence, RI
National Provider Identifier
1821558669
Registry record updated Jul 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Emergency Medicine (Pediatrics) PhysicianTaxonomy code 2080P0204X
License
MD20685 Issued in RI
Practice address
593 Eddy St.
Claverick 2
Providence, RI 02903
Phone
(401) 444-4000
NPI assigned
Mar 20, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X 77195 WI
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X MD20685 RI Primary

Addresses

Primary practice location

593 Eddy St.
Claverick 2
Providence, RI 02903

Mailing address

110 Elm St
Providence, RI 02903-4626
Phone (401) 444-4000

Other practice location 1

9000 W Wisconsin Ave
Milwaukee, WI 53226-4874
Phone (414) 266-2625

Other identifiers 1

IdentifierTypeStateIssuer
1821558669MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, 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
I20230622002411 WI Practitioner - Emergency MedicinePractitioner - Pediatric Medicine 2466786835 Reassigns benefits to 1 organization
I20250819000509 RI Practitioner - Pediatric Medicine 2466786835 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
University of Vermont College of Medicine, 2019
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

55 Claverick St
FL 2
Providence, RI 02903-4144

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
77195WIMDPediatric Emergency Medicine (Pediatrics) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lifespan Physician Group Inc CurrentSince Feb 1, 2026 Accepting new patients
The Medical College of Wisconsin, Inc. CurrentSince Jul 1, 2023 Accepting new patients
Brown Emergency Medicine Pediatric Emergency Medicine CurrentSince Sep 1, 2025 Accepting new patients
Lifespan Physician Group, Inc. Pediatric Emergency Medicine CurrentSince Feb 1, 2026 Accepting new patients

Locations

55 Claverick St
Fl 2
Providence, RI 02903

110 Elm St
Providence, RI 02903
Phone (401) 443-4992

593 Eddy St
#2
Providence, RI 02903
Phone (401) 519-1604

593 Eddy St
Providence, RI 02903

9000 W Wisconsin Ave
Wauwatosa, WI 53226
Phone (414) 266-2625

8701 Watertown Plank Rd
Wauwatosa, WI 53226
Phone (414) 456-4100

Organizations & group practices 5

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": "1553040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752624000000",
    "number": "1821558669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 ELM ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034626",
            "telephone_number": "401-444-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "593 EDDY ST.",
            "address_2": "CLAVERICK 2",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "02903",
            "telephone_number": "401-444-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9000 W Wisconsin Ave",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532264874",
            "country_code": "US",
            "telephone_number": "414-266-2625",
            "fax_number": "414-266-2635",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WHITE",
        "first_name": "NATHANIEL",
        "middle_name": "EBBETS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-20",
        "last_updated": "2025-07-16",
        "certification_date": "2025-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "WI",
            "license": "77195",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "RI",
            "license": "MD20685",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1821558669",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.