Ghulam Mustafa Surti, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

MD09937 Issued in RI

Practice address

345 Blackstone Blvd
Providence, RI 02906-4800

Phone

(401) 455-6200

Fax

(401) 455-6309

NPI assigned

Jul 7, 2005

Last updated

Feb 28, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 9

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in RI, CA2 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

Specialty

PsychiatryAlso: Geriatric Psychiatry

Education

Other, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Affinity Physicians LLC.Group PAC ID 0244413391, 723 clinicians

Harbor Psychiatry and Mental Health Professional CorporationGroup PAC ID 8729394572, 19 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Kent County Memorial Hospital Hospital, Warwick, RI, CCN 410009

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: gsurti@kent.cernerdirect.carene.org
• Direct secure messaging: gsurti8948@direct.carene.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Affinity Physicians LLC.

  • Internal Medicine Physician
  • Warwick, RI
  • NPI 1184944662

  Psychiatry

  Medicare reassignment Care Compare group NPD
• Embrace Healing Psychiatric Services, LLC

  • Psychiatry Physician
  • Providence, RI
  • NPI 1679977342
  Medicare reassignment NPD Authorized official
• Harbor Psychiatry & Mental Health, Professional Corporation

  • Psychiatry Physician
  • Newport Beach, CA
  • NPI 1780050054
  Medicare reassignment Care Compare group NPD
• Prospect Chartercare RWMC, LLC

  dba Roger Williams Medical Center

  • Internal Medicine Physician
  • Providence, RI
  • NPI 1285059287
  Medicare reassignment NPD
• Prospect Chartercare Sjhsri, LLC

  dba Our Lady of Fatima Hospital

  • Internal Medicine Physician
  • North Providence, RI
  • NPI 1588089759

  Psychiatry

  Medicare reassignment NPD
• The Providence Center Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Providence, RI
  • NPI 1104847946

  Psychiatry

  Medicare reassignment NPD
• Affinity Physicians LLC

  • Anesthesiology Physician
  • Providence, RI
  • NPI 1053038471
  NPD
• Prospect Chartercare RWMC, LLC

  dba Roger Williams Medical Center

  • Cardiovascular Disease Physician
  • Providence, RI
  • NPI 1326463548
  NPD
• Prospect Chartercare Sjhsri, LLC

  dba Our Lady of Fatima Hospital

  • General Acute Care Hospital
  • North Providence, RI
  • NPI 1871918870
  NPD
• Rhode Island Hospital

  • General Acute Care Hospital
  • Providence, RI
  • NPI 1972768174
  NPD (past)
• The Providence Center

  • Community/Behavioral Health Agency
  • Providence, RI
  • NPI 1134977598

  Psychiatry

  NPD (past)
• Medoptions Behavioral Health Assoc, LLC

  • Nurse Practitioner
  • Old Saybrook, CT
  • NPI 1588604060

  Psychiatry

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Kent County Memorial Hospital

  dba Kent County Hospital Rehab Unit

  • Rehabilitation Hospital Unit
  • Warwick, RI
  • NPI 1023017944
  Care Compare affiliation
• Kent County Memorial Hospital

  • General Acute Care Hospital
  • Warwick, RI
  • NPI 1386643294
  Care Compare affiliation

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677542400000",
    "number": "1861499675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 BLACKSTONE BLVD",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029064800",
            "telephone_number": "401-455-6200",
            "fax_number": "401-455-6309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 BLACKSTONE BLVD",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029064800",
            "telephone_number": "401-455-6200",
            "fax_number": "401-455-6309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SURTI",
        "first_name": "GHULAM",
        "middle_name": "MUSTAFA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2023-02-28",
        "certification_date": "2023-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "RI",
            "license": "MD09937",
            "primary": true
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "RI",
            "license": "MD09937",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID-TYPE UNSPECIFIED",
            "identifier": "007008181",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00362436",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUTLER HOSPITAL NPI",
            "identifier": "1104801349",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "23998-5",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHIP",
            "identifier": "406629",
            "state": "RI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GS29847",
            "state": "RI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02246624",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUTLER HOSPITAL PROFESSIONAL BILLING OFFICE",
            "identifier": "1093831646",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED BEHAVIORAL HEALTH",
            "identifier": "15-43150",
            "state": "RI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gsurti8948@direct.carene.org",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "345 Blackstone Blvd",
            "city": "Providence",
            "state": "RI",
            "country_code": "US",
            "postal_code": "029064800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Surgical & Cosmetic Dermatology of Rhode Island, LLC
• Tinatin Surguladze, DH.D.
• Michelle Elizabeth Suriani, MS, RD
• Cindy Surin
• Claire Surkis
• Susan Aubut
• Malcolm Rose Sushchyk, LICSW 00012367
• Tanya Sutcliffe, MD
• Eric Paul Sutherland, RPH
• Grace Faith Suttle, MD

• Psychiatry Physician in Providence, RI
• Providers in Providence, RI by specialty
• Psychiatry Physician in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.