Active NPI
Kenneth C. Rickler, MD
- Neurology Physician
- Providence, RI
National Provider Identifier
1902810369
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- MD08987
- Practice address
- 345 Blackstone Blvd
Providence, RI 02906-4800 - Phone
- (401) 455-6200
- Fax
- (401) 455-6309
- NPI assigned
- Jul 28, 2006
- Last updated
- May 20, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | MD08987 | RI | Primary |
Addresses
Primary practice location
345 Blackstone Blvd
Providence, RI 02906-4800
Mailing address
345 Blackstone Blvd
Providence, RI 02906-4800
Phone (401) 455-6200
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 25226-5 | Other | RI | BLUE CROSS |
| 1104801349 | Other | RI | BUTLER HOSPITAL NPI |
| 204792 | Other | RI | BLUE CHIP |
| 05-00163 | Other | RI | UNITED HEALTHCARE |
| 9025246 | Medicaid | RI | |
| 1093831646 | Other | RI | BUTLER HOSPITAL PROFESSIONAL BILLING OFFICE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD08987 | RI | MD | Neurology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211241600000",
"number": "1902810369",
"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": "RICKLER",
"first_name": "KENNETH",
"middle_name": "C.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-28",
"last_updated": "2008-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "RI",
"license": "MD08987",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "25226-5",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BUTLER HOSPITAL NPI",
"identifier": "1104801349",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CHIP",
"identifier": "204792",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "05-00163",
"state": "RI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9025246",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BUTLER HOSPITAL PROFESSIONAL BILLING OFFICE",
"identifier": "1093831646",
"state": "RI"
}
],
"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 May 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.