East Bay Community Action Program
Organization Active NPI Dental Clinic/Center · Newport, RI
NPI 1861439705 · NPPES record last updated Mar 11, 2025
Key facts
- NPI
- 1861439705
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dental Clinic/Center 261QD0000X
- Legal business name
- EAST BAY COMMUNITY ACTION PROGRAM
- Practice address
- 19 Broadway
Newport, RI 02840-2937 - Phone
- (401) 848-6697
- Fax
- (401) 847-6220
- NPI assigned
- May 31, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Rilwan Feyisitan
- Title
- Ceo
- Phone
- (401) 848-6697
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 4
Practitioners 55
-
Jacob T Abraham, MD
-
Maria T Gilman, APRN
-
Karen Last, NURSE PRACTITIONER P
-
John S Corvese, O.D.
-
Leanne Craven, LICSW, LCDP
-
Eileen Curran, LICSW
-
Lisa Rachelle Denny, M.D.
-
Rachel Marie Dirosario, APRN
-
Doreen Donnelly, NP
-
Diane Marie Fletcher, RN, NP
-
Rose A Goulet, LICSW
-
Spence Hobbs, MSW, LICSW
-
Nelsy Lopes, PA
-
Shane McNamara Gazzo, PA-C
-
Baila Mir, PA
-
Joseph B. Singer, MD
-
Mark C Zeller, DO
-
Stephanie Beth Lee, PA-C, MPH
-
Ashley Marie Debont, LICSW
-
Cheryl Del Padre, LICSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (4 enrollments) in RI
Federally qualified health center certification: CCN 411813
- Legal name
- EAST BAY COMMUNITY ACTION PROGRAM
- Doing business as
- NEW VISIONS
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jan 22, 2001
- Last certification
- Jan 22, 2001
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Apr 12, 1965 in RI
- Enrollment address
- 19 Broadway
Newport, RI 28402937
Federally qualified health center certification: CCN 411803
- Legal name
- EAST BAY COMMUNITY ACTION PROGRAM
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jan 1, 1993
- Last certification
- Jan 1, 1993
- Ownership / control type
- For profit – corporation
- Most recent change of ownership
- Nov 1, 2003 (1 total)
- Organization structure
- Corporation · Non-profit
- Incorporated
- Apr 12, 1965 in RI
- Enrollment address
- 100 Bullocks Point
Riverside, RI 29155351
Federally qualified health center certification: CCN 411846
- Legal name
- EAST BAY COMMUNITY ACTION PROGRAM
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Sep 2, 2014
- Last certification
- Sep 2, 2014
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Apr 12, 1965 in RI
- Enrollment address
- 6 John H Chafee Blvd
Newport, RI 28401034
All disclosed owners & managing parties 20
| Name | Role | Since | Share |
|---|---|---|---|
| Kathleen Ann Charbonneau |
Corporate Director |
Apr 22, 2014 | |
| Linda Dipalma |
Corporate Director |
Apr 24, 2012 | |
| Anne Richardson |
Corporate Director | Jan 1, 2019 | |
| Corporate Director |
Feb 23, 2016 | ||
| Barbara Haskell |
Corporate Officer | Jan 1, 2019 | |
| Corporate Director | Jun 27, 2006 | ||
| Corporate Director |
Jun 27, 2006 | ||
| Edward Carusi |
Corporate Director |
Jun 26, 2007 | |
| Karen C Ferrara |
Corporate Director |
Feb 26, 2013 | |
| Rilwan Feyisitan |
Contracted Managing Employee |
Feb 1, 2023 | |
| Corporate Officer | Feb 1, 2023 | ||
| Corporate Officer |
Feb 1, 2023 | ||
| Corporate Officer |
Jan 16, 2023 | ||
| W-2 Managing Employee | Jan 16, 2023 | ||
| Jane Koster |
Corporate Director |
Jul 27, 2004 | |
| David Bebyn |
Corporate Officer | Jan 1, 2019 | |
| Corporate Director |
Jul 28, 2015 | ||
| Lori Silveira |
Corporate Officer | Jan 1, 2019 | |
| Corporate Director | Jan 1, 2019 | ||
| Julianne McCarthy |
Corporate Officer | Jan 1, 2019 | |
| Corporate Director | Jan 1, 2019 | ||
| Corporate Director |
Feb 23, 2016 | ||
| Jeyson Galvez |
Corporate Officer | Jan 1, 2019 | |
| Corporate Director | Jan 1, 2019 | ||
| Julie Chalue |
Corporate Director |
Nov 22, 2011 | |
| Laurie Simonds |
Corporate Director |
Jul 27, 2004 | |
| James Vincent |
Corporate Director |
Jul 27, 2004 | |
| Gregory Dias |
Corporate Director |
Jan 23, 2007 | |
| Tracy Cooper-Ramos |
Corporate Director | May 31, 2022 | |
| Justine Cordeiro |
Corporate Officer |
Apr 28, 2023 | |
| John Taylor |
Corporate Director | Mar 29, 2022 | |
| Jessica Calvino |
Corporate Director |
Feb 23, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040301000102 | RI | Part B Supplier - Clinic/Group Practice | 1951298595 |
Receives reassigned benefits from 68 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Barrington, RI; East Providence, RI; Middletown, RI; Newport, RI; Riverside, RI |
| O20040407001561 | RI | Part a Provider - Federally Qualified Health Center (FQHC) | 1951298595 |
2 other NPIs on this enrollment Practice locations: Newport, RI |
| O20040623000437 | RI | Part a Provider - Federally Qualified Health Center (FQHC) | 1951298595 |
2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Riverside, RI |
| O20140829000799 | RI | Part a Provider - Federally Qualified Health Center (FQHC) | 1951298595 |
2 other NPIs on this enrollment Practice locations: Newport, RI |
National Provider Directory
- Tax ID family
- New Visions for Newport
Locations
610 Waterman Ave
East Providence, RI 02914
Phone (401) 435-7800
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Clinic/Center | 261QD0000X | Yes | ||
| Federally Qualified Health Center (FQHC) | 261QF0400X | 01520 | RI |
Addresses
Primary practice location
19 Broadway
Newport, RI 02840-2937
Mailing address
19 Broadway
Newport, RI 02840-2937
Phone (401) 848-6697
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| EB51407 | Medicaid | RI |
Other providers in Newport, RI
- Latasha Marie Duarte
- Susan Rae Dubois
- Margaret Reagan Dupont
- Sarah Durr
- Ralph Thomas Earp
- East Bay Communtiy Action Program
- East Bay Psychological Services LLC
- Eat to Live
- Samuel Hamilton Eaton
- Jenna Eccleston
All providers in Newport, RI · Dental Clinic/Center in Rhode Island
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 11, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.