NPIMap

Individual provider Active NPI

Jason Charles Xynellis, PA-C

  • Medical Physician Assistant
  • Providence, RI
National Provider Identifier
1952501942
Registry record updated Nov 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA00501 Issued in RI
Practice address
1195 N Main St
Providence, RI 02904-1824
Phone
(401) 331-8555
NPI assigned
Jul 19, 2007
Last updated
Nov 30, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA00501 RI Primary

Addresses

Primary practice location

1195 N Main St
Providence, RI 02904-1824

Mailing address

1195 N Main St
Providence, RI 02904-1824
Phone (401) 331-8555

Other identifiers 2

IdentifierTypeStateIssuer
JX84601MedicaidRI
0021338OtherRIMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110601000406 RI Practitioner - Physician Assistant 2062596299 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Oceanside Aesthetics, LLCGroup PAC ID 2466829791, 2 clinicians
Carewell Urgent Care of Rhode Island PCGroup PAC ID 5799937470, 9 clinicians

Practice addresses (Care Compare)

300 Toll Gate Rd
Suite 207
Warwick, RI 02886-4448
Phone (401) 384-7501

535 Centerville Rd
Suite 102
Warwick, RI 02886-4376
Phone (401) 773-7220

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA00501RIMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Neurological Clinical Associate PC Past Accepting new patients
Newport County Medical Treatment Office Past Accepting new patients
Neurological Associates of Albany, PC PastSince Jan 8, 2008 Accepting new patients
Memorial Hospital Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: jason.xynellis.1@30105.direct.athenahealth.com

Organizations & group practices 7

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

Hospital & facility affiliations 3

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": "1184803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354233600000",
    "number": "1952501942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1195 N MAIN ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029041824",
            "telephone_number": "401-331-8555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1195 N MAIN ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029041824",
            "telephone_number": "401-331-8555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "XYNELLIS",
        "first_name": "JASON",
        "middle_name": "CHARLES",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-19",
        "last_updated": "2012-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "RI",
            "license": "PA00501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "JX84601",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "0021338",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.