Kaitlyn Ruane
Individual provider Active NPI Physician Assistant · Providence, RI
NPI 1891547550 · NPPES record last updated Aug 12, 2024
Key facts
- NPI
- 1891547550
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA01717 (RI)
- Practice address
- 593 Eddy St
Providence, RI 02903-4923 - Phone
- (401) 444-4000
- NPI assigned
- Apr 4, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in RI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240820003159 | RI | Practitioner - Physician Assistant | 2466990528 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lifespan Physician Group, Inc. | Pediatric Emergency Medicine | Current |
Accepting new patients |
| Lifespan Corporation | Current | Accepting new patients | |
| Lifespan Physician Group Inc | Current |
Accepting new patients |
Locations
593 Eddy St
Providence, RI 02903
Interoperability endpoints
- kruane217238@brownhealth.medalliesdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA01717 | RI | Yes |
Addresses
Primary practice location
593 Eddy St
Providence, RI 02903-4923
Mailing address
125 Whipple St Ste 3
Providence, RI 02908-3258
Other providers in Providence, RI
- James Rozelle
- Julia Rozenberg
- Nancy Rozendal
- Ranna A Rozenfeld
- Sydney Ilana Rozenfeld
- Jonathan Rubin
- Leah Rubin
- Lowell J. Rubin
- Mahra B Rubinstein
- Michael L Rubinstein
All providers in Providence, RI · Physician Assistant 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 Aug 12, 2024. 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.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.