Individual provider Active NPI

Derric James Vigeant

  • Physician Assistant
  • Providence, RI
National Provider Identifier
1902546203
Registry record updated May 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
825 Chalkstone Ave
Providence, RI 02908-4728
Phone
(401) 456-2000
NPI assigned
Apr 1, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X PA1450 RI
Child & Family Psychiatric/Mental Health Clinical Nurse Specialist 364SP0810X PA01450 RI
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

825 Chalkstone Ave
Providence, RI 02908-4728

Mailing address

646 Greenville Ave
Johnston, RI 02919-1331
Phone (401) 426-9887

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220518001940 RI Practitioner - Physician Assistant 4789061458 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Supportive Care I of Rhode Island PCGroup PAC ID 1951793546, 53 clinicians
Prospect Chartercare RWMC, LLCGroup PAC ID 0547492696, 66 clinicians

Practice addresses (Care Compare)

17 Adelphi Ave
Providence, RI 02906-4119
Phone (718) 298-4375

825 Chalkstone Ave
Providence, RI 02908-4728
Phone (401) 456-2026

825 Chalkstone Ave
Providence, RI 02908-4735

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA1450RIMDPsychiatric/Mental Health Nurse Practitioner
PA01450RIMDChild & Family Psychiatric/Mental Health Clinical Nurse Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Prospect Chartercare Sjhsri, LLC CurrentSince Jun 9, 2022 Accepting new patients
Supportive Care I of Rhode Island PC CurrentSince Nov 1, 2025 Accepting new patients
Prospect Chartercare RWMC, LLC CurrentSince Jun 9, 2022 Accepting new patients
Prospect Chartercare Sjhsri, LLC CurrentSince Jun 9, 2022 Accepting new patients
Prospect Chartercare RWMC, LLC CurrentSince Jun 9, 2022 Accepting new patients
Roger Williams Medical Center Past Accepting new patients

Locations

27 Randolph Rd
Howell, NJ 07731
Phone (972) 677-7951

2 Wake Robin Rd
Lincoln, RI 02865
Phone (401) 333-1747

200 High Service Ave
North Providence, RI 02904
Phone (401) 456-3000

825 Chalkstone Ave
Providence, RI 02908
Phone (401) 456-2000

Organizations & group practices 8

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

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1648771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652054400000",
    "number": "1902546203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "646 GREENVILLE AVE",
            "city": "JOHNSTON",
            "state": "RI",
            "postal_code": "029191331",
            "telephone_number": "401-426-9887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 CHALKSTONE AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029084728",
            "telephone_number": "401-456-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIGEANT",
        "first_name": "DERRIC",
        "middle_name": "JAMES",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-01",
        "last_updated": "2022-05-09",
        "certification_date": "2022-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "RI",
            "license": "PA1450",
            "primary": false
        },
        {
            "code": "364SP0810X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Psychiatric/Mental Health, Child & Family",
            "state": "RI",
            "license": "PA01450",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.