NPIMap

Organization Active NPI

Supportive Care I of Rhode Island PC

  • Clinical Psychologist
  • Providence, RI
National Provider Identifier
1912666454
Registry record updated Dec 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
SUPPORTIVE CARE I OF RHODE ISLAND PC
Practice address
17 Adelphi Ave
Providence, RI 02906-4119
Phone
(718) 298-4375
NPI assigned
Dec 13, 2021
Last updated
Dec 13, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2021

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

Authorized official

Name
Dov Newmark
Title
President
Phone
(718) 298-4375

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X Primary

Addresses

Primary practice location

17 Adelphi Ave
Providence, RI 02906-4119

Mailing address

27 Randolph Rd
Howell, NJ 07731-8611
Phone (718) 298-4375

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220111000885 RI Part B Supplier - Clinic/Group Practice 1951793546 Receives reassigned benefits from 92 practitioners
Practice locations: Providence, RI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 97

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.

View all 97

NPI Registry JSON

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

{
    "created_epoch": "1639353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639353600000",
    "number": "1912666454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27 RANDOLPH RD",
            "city": "HOWELL",
            "state": "NJ",
            "postal_code": "077318611",
            "telephone_number": "718-298-4375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 ADELPHI AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029064119",
            "telephone_number": "718-298-4375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPPORTIVE CARE I OF RHODE ISLAND PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-13",
        "last_updated": "2021-12-13",
        "certification_date": "2021-12-13",
        "status": "A",
        "authorized_official_last_name": "NEWMARK",
        "authorized_official_first_name": "DOV",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-298-4375"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "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 Dec 13, 2021; 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.