Walter Deluca, PAC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA00002 Issued in RI

Practice address

684 Warren Ave
East Providence, RI 02914-1405

Phone

(401) 434-0022

Fax

(401) 434-6111

NPI assigned

Oct 4, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in RI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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

• Primary Medical Center and Walk-in LLC

  • Family Medicine Physician
  • East Providence, RI
  • NPI 1225444243
  Medicare reassignment
• Primary Walk-in Medical Urgent Care LLC

  • Urgent Care Clinic/Center
  • East Providence, RI
  • NPI 1790260974
  Medicare reassignment
• Memorial Hospital

  • General Acute Care Hospital
  • Pawtucket, RI
  • NPI 1548696941
  NPD (past)

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1537228800000",
    "number": "1962598516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "684 WARREN AVE",
            "city": "EAST PROVIDENCE",
            "state": "RI",
            "postal_code": "029141405",
            "telephone_number": "401-434-0022",
            "fax_number": "401-434-6111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "684 WARREN AVE",
            "city": "EAST PROVIDENCE",
            "state": "RI",
            "postal_code": "029141405",
            "telephone_number": "401-434-0022",
            "fax_number": "401-434-6111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DELUCA",
        "first_name": "WALTER",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2018-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MT",
            "license": "289",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "RI",
            "license": "PA00002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7005920",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LIC NUMBER",
            "identifier": "289",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS NUMBER",
            "identifier": "000096303",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "979006386",
            "state": "RI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0438260",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emily Snow Delconte, RD
• Kaitlynn Delisle, OT
• Marianela Delossantos, NP
• Joseph Delsesto, RPH
• Daniel Deluca, DPT
• Kelly Bettez Desimone, PT
• Banreet Singh Dhindsa
• Margaret Ann Dicarlo, PH.D.
• Daniel Paul Dickstein, M.D.
• Susan Dickstein, PHD

• Medical Physician Assistant in East Providence, RI
• Providers in East Providence, RI by specialty
• Medical Physician Assistant in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.