Paul William Roderick, M.D.

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

RI5529 Issued in RI

Practice address

1150 Reservoir Ave
Suite 201
Cranston, RI 02920-6068

Phone

(401) 943-1300

Fax

(401) 946-8480

NPI assigned

Sep 6, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• University Gastroenterology, LLC

  • Gastroenterology Physician
  • Providence, RI
  • NPI 1386952612
  NPD (past)

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

{
    "created_epoch": "1125964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269388800000",
    "number": "1831183904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 RESERVOIR AVE",
            "address_2": "SUITE 201",
            "city": "CRANSTON",
            "state": "RI",
            "postal_code": "029206068",
            "telephone_number": "401-943-1300",
            "fax_number": "401-946-8480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 RESERVOIR AVE",
            "address_2": "SUITE 201",
            "city": "CRANSTON",
            "state": "RI",
            "postal_code": "029206068",
            "telephone_number": "401-943-1300",
            "fax_number": "401-946-8480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODERICK",
        "first_name": "PAUL",
        "middle_name": "WILLIAM",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-06",
        "last_updated": "2010-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "RI",
            "license": "RI5529",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "IM02288",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joseph R Robitaille, CAGS, BCBA
• Marjorie L Roblin, LICSW
• Deryl JC Robson
• Jasmine Roca, MSW
• Robert A Rocchio Jr., MSW, LICSW, CGS
• Ivy Elizabeth Rollins Milliken, PH.D.
• Dennis J Romano, MD
• Lisa Joy Romeo Disanto, RPH
• Tony B Romeo, SLP-CF
• Jennifer Rondeau, MHC00224

• Gastroenterology Physician in Cranston, RI
• Providers in Cranston, RI by specialty
• Gastroenterology Physician in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.