NPIMap

Organization Active NPI

Integrated Wound Care Rhode Island PLLC

  • General Practice Physician
  • Providence, RI
National Provider Identifier
1871063891
Registry record updated Mar 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
INTEGRATED WOUND CARE RHODE ISLAND PLLC
Practice address
50 Maude St
Providence, RI 02908-4325
Phone
(732) 451-4318
NPI assigned
Dec 3, 2018
Last updated
Mar 28, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2019

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

Authorized official

Name
Dr. Diane Lusas, MDNPI 1730475658
Title
Member
Phone
(732) 451-4318

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X Primary

Addresses

Primary practice location

50 Maude St
Providence, RI 02908-4325

Mailing address

492C Cedar LN Ste 514
Teaneck, NJ 07666-1713

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190322001877 RI Part B Supplier - Clinic/Group Practice 2668712928 Receives reassigned benefits from 9 practitioners
Practice locations: Providence, RI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1543795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553731200000",
    "number": "1871063891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "492C CEDAR LN STE 514",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076661713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 MAUDE ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029084325",
            "telephone_number": "732-451-4318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED WOUND CARE RHODE ISLAND PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-03",
        "last_updated": "2019-03-28",
        "status": "A",
        "authorized_official_last_name": "LUSAS",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "732-451-4318",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.