Nicole Roy, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

11 Mount Auburn St
Watertown, MA 02472-3981

Phone

(844) 377-4199

NPI assigned

Sep 18, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Nicole Kenneally Former name

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nroy169817@brownhealth.medalliesdirect.net
• Direct secure messaging: nkenneally169817@brownhealth.medalliesdirect.net

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.

• Brown Emergency Medicine

  • Emergency Medicine Physician
  • Providence, RI
  • NPI 1962455022
  Medicare reassignment
• Coastal Medical Physicians, Inc.

  • Internal Medicine Physician
  • Providence, RI
  • NPI 1780273540
  Medicare reassignment
• Coastal Medical Physicians, Inc.

  • Internal Medicine Physician
  • Riverside, RI
  • NPI 1093678104
  NPD
• Lifespan Corporation

  • Children's Rehabilitation Hospital
  • Providence, RI
  • NPI 1790221232
  NPD
• Ocean State Urgent Care Center of Woonsocket

  • Family Medicine Physician
  • Woonsocket, RI
  • NPI 1073973574
  NPD
• Coastal Medical, Inc.

  • Non-Pharmacy Dispensing Site
  • East Providence, RI
  • NPI 1144361718
  NPD (past)
• David Carpentier, MD Family Healthcare LTD

  • Emergency Medicine Physician
  • Cranston, RI
  • NPI 1144296054
  NPD (past)

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

{
    "created_epoch": "1505692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699401600000",
    "number": "1831618149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 WARREN AVE STE 200",
            "city": "EAST PROVIDENCE",
            "state": "RI",
            "postal_code": "029141430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 MOUNT AUBURN ST",
            "city": "WATERTOWN",
            "state": "MA",
            "postal_code": "024723981",
            "telephone_number": "844-377-4199"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "900 Warren Ave Ste 200",
            "address_purpose": "LOCATION",
            "city": "East Providence",
            "state": "RI",
            "postal_code": "029141430",
            "country_code": "US",
            "telephone_number": "401-421-6481",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2140 Mendon Rd",
            "address_purpose": "LOCATION",
            "city": "Cumberland",
            "state": "RI",
            "postal_code": "028643843",
            "country_code": "US",
            "telephone_number": "401-642-2072",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROY",
        "first_name": "NICOLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-18",
        "last_updated": "2023-11-08",
        "certification_date": "2023-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "KENNEALLY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Larry H Roth, M.D.
• David Aaron Rouby, C.O.M.S.
• Jillian Rouse, OTR/L
• Beth Blandford Rousseau
• Christine Anne Routhier, LMHC, MT-BC
• Victoria Rozzi
• RT Wellness Center LLC
• Daniel Rutrick, M.D.
• Sarah Ryan, MA OTRL
• Fabiana Saad, NP

• Physician Assistant in Watertown, MA
• Providers in Watertown, MA by specialty
• Physician Assistant in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2023; 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.