Individual provider Active NPI

Katherine V Chadurjian, PA

  • Physician Assistant
  • Providence, RI
National Provider Identifier
1992040471
Registry record updated Dec 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA00690 Issued in RI
Practice address
593 Eddy St
Claverick 2
Providence, RI 02903-4923
Phone
(401) 444-4000
NPI assigned
Dec 10, 2012
Last updated
Dec 13, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Physician Assistant 363A00000X PA00690 RI Primary

Addresses

Primary practice location

593 Eddy St
Claverick 2
Providence, RI 02903-4923

Mailing address

PO Box 9484
Providence, RI 02940-9484
Phone (401) 854-2500

Other practice location 1

593 Eddy St
Claverick 2
Providence, RI 02903-4923
Phone (401) 854-2504

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kchadurjian59314@HCNetwork.direct-ci.com

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20130423000280 RI Practitioner - Physician Assistant 0648416487 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

355 Prairie Ave
Providence, RI 02905-1928
Phone (401) 444-0570

375 Allens Ave
Providence, RI 02905-5010
Phone (401) 444-0400

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA00690RIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The Providence Community Health Centers, Inc CurrentSince Mar 6, 2023 Accepting new patients
The Providence Community Health Centers Inc. Past Accepting new patients

Locations

31 Atwood St
Providence, RI 02909
Phone (401) 415-9000

375 Allens Ave
Providence, RI 02905
Phone (401) 444-0400

Interoperability endpoints

  • Direct secure messaging: kchadurjian59314@hcnetwork.direct-ci.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1355097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702425600000",
    "number": "1992040471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9484",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029409484",
            "telephone_number": "401-854-2500",
            "fax_number": "401-854-2519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "593 EDDY ST",
            "address_2": "CLAVERICK 2",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029034923",
            "telephone_number": "401-444-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "593 Eddy St",
            "address_2": "Claverick 2",
            "address_purpose": "LOCATION",
            "city": "Providence",
            "state": "RI",
            "postal_code": "029034923",
            "country_code": "US",
            "telephone_number": "401-854-2504",
            "fax_number": "401-854-2519",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHADURJIAN",
        "first_name": "KATHERINE",
        "middle_name": "V",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-12-10",
        "last_updated": "2023-12-13",
        "certification_date": "2023-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "RI",
            "license": "PA00690",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kchadurjian59314@HCNetwork.direct-ci.com",
            "affiliation": "N",
            "address_1": "355 Prairie Ave",
            "city": "Providence",
            "state": "RI",
            "country_code": "US",
            "postal_code": "029051928",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.