John Concannon, DO
Individual provider Active NPI Pediatrics Physician · Cranston, RI
NPI 1962409128 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1962409128
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- DO-00357 (RI)
- Practice address
- 1145 Reservoir Ave
Suite 124
Cranston, RI 02920-6055 - Phone
- (401) 943-7337
- Fax
- (401) 942-1509
- NPI assigned
- Jul 2, 2005
- Reactivated
- Mar 25, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
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: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110201000719 | RI | Practitioner - Pediatric Medicine | 6305025792 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DRS. Concannon and Vitale, LLC | Pediatrics | Current |
Accepting new patients |
Locations
1145 Reservoir Ave
Cranston, RI 02920
Phone (401) 228-6010
1145 Reservoir Ave
Ste 124
Cranston, RI 02920
Phone (401) 943-7337
Interoperability endpoints
- jconcannon@direct.carene.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | DO-00357 | RI | Yes |
Addresses
Primary practice location
1145 Reservoir Ave
Suite 124
Cranston, RI 02920-6055
Mailing address
1145 Reservoir Ave
Suite 124
Cranston, RI 02920-6055
Phone (401) 943-7337
Other providers in Cranston, RI
- Comprehensive Community Action, Inc
- Comprehensive Community Action, Inc
- Comprehensive Community Action, Inc.
- Comprehensive Home Medical Equipment Inc
- Comprehensive OB/GYN Care, Inc
- Concord Health Services, Inc
- Concord Physical Therapy Inc.
- Alanna Conley
- Moriah Connor
- Jonathan D Considine
All providers in Cranston, RI · Pediatrics Physician 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 Jul 8, 2007. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.