Michael Elliot Whalen, PA
Individual provider Active NPI Physician Assistant · Providence, RI
NPI 1922470533 · NPPES record last updated Mar 25, 2024
Key facts
- NPI
- 1922470533
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA01153 (RI)
- Practice address
- 164 Summit Ave
Providence, RI 02906-2853 - Phone
- (401) 793-4102
- Fax
- (401) 793-4049
- NPI assigned
- Oct 21, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Lifespan Physician Group Inc
Practice addresses (Care Compare)
164 Summit Ave
Providence, RI 02906-2853
185 A High Service Ave
North Providence, RI 02904-5114
Phone (401) 354-6050
185 High Service Ave
North Providence, RI 02904-5114
Phone (401) 354-6050
Hospital & facility affiliations
- The Miriam Hospital
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 |
|---|---|---|---|---|
| I20200117001477 | RI | Practitioner - Physician Assistant | 2163726506 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA01153 | RI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lifespan Physician Group, Inc. | Physician Assistant | Current |
Accepting new patients |
| Lifespan Physician Group, Inc. | Current |
Accepting new patients |
Locations
1 Commerce St
Ste 100
Lincoln, RI 02865
Phone (401) 793-8444
1 Commerce St
Ste 200
Lincoln, RI 02865
Phone (401) 793-8500
185A High Service Ave
North Providence, RI 02904
Phone (401) 354-6050
164 Summit Ave
Providence, RI 02906
Phone (401) 793-2104
117 Ellenfield St
Ste 101
Providence, RI 02905
Phone (401) 444-4318
Interoperability endpoints
- michael.whalen.1@10.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA5543 | MA | |
| Physician Assistant | 363A00000X | PA01153 | RI | Yes |
Addresses
Primary practice location
164 Summit Ave
Providence, RI 02906-2853
Mailing address
117 Ellenfield St Ste 101
Providence, RI 02905-4541
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | michael.whalen.1@10.direct.athenahealth.com |
Other providers in Providence, RI
- Amy Joy Westrick
- Judith Blazar Westrick
- Westside Psychology LLC
- Bryanna Rose Wetherell
- Albert K Weyman
- Colleen Madden Wham
- Gary Wharton
- Aaron Paul Wheeler
- Carol Anne Wheeler
- Cheryl Wheeler
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 Mar 25, 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.