Individual provider Active NPI

Carolynn Joy A Nassar, MD

  • Internal Medicine Physician
  • Riverside, RI
National Provider Identifier
1871812552
Registry record updated Jun 8, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD14398 Issued in RI
Practice address
375 Wampanoag TRL
Suite 201
Riverside, RI 02915-2232
Phone
(401) 649-4020
Fax
(401) 649-4021
NPI assigned
May 20, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD14398 RI Primary

Addresses

Primary practice location

375 Wampanoag TRL
Suite 201
Riverside, RI 02915-2232

Mailing address

110 Elm St
Providence, RI 02903-4626
Phone (877) 771-7401

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20250130003231 RI Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 3779719653

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD14398RIMDInternal Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1274313600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528416000000",
    "number": "1871812552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 ELM ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034626",
            "telephone_number": "877-771-7401",
            "fax_number": "401-784-4902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 WAMPANOAG TRL",
            "address_2": "SUITE 201",
            "city": "RIVERSIDE",
            "state": "RI",
            "postal_code": "029152232",
            "telephone_number": "401-649-4020",
            "fax_number": "401-649-4021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NASSAR",
        "first_name": "CAROLYNN JOY",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-05-20",
        "last_updated": "2018-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "RI",
            "license": "MD14398",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, RI

Sources for this page

Verify at the official NPI Registry.