NPIMap

Individual provider Active NPI

Jacqueline D Michaud, DO

  • Internal Medicine Physician
  • Providence, RI
National Provider Identifier
1992745111
Registry record updated Aug 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
DO00523 Issued in RI
Practice address
593 Eddy St
Providence, RI 02903
Phone
(401) 444-3985
Fax
(401) 444-3986
NPI assigned
Jun 7, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X DO00523 RI Primary

Addresses

Primary practice location

593 Eddy St
Providence, RI 02903

Mailing address

117 Ellenfield St Ste 101
Providence, RI 02905-4513
Phone (401) 444-6779

Other identifiers 1

IdentifierTypeStateIssuer
9021376MedicaidRI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI, TX, GU3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20040616000205 RI Practitioner - Emergency MedicinePractitioner - Internal Medicine 9931183084 Reassigns benefits to 1 organization
I20161109001618 TX Practitioner - Infectious DiseasePractitioner - Internal Medicine 9931183084 Reassigns benefits to 2 organizations
I20170126001765 GU Practitioner - Internal Medicine 9931183084 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency MedicineAlso: Internal Medicine
Education
Philadelphia College of Osteopathic Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lifespan Physician Group IncGroup PAC ID 2567455082, 1,151 clinicians
DHHS PHS Naihs Shiprock HospitalGroup PAC ID 0749193837, 148 clinicians

Practice addresses (Care Compare)

593 Eddy St
Providence, RI 02903-4923
Phone (401) 444-4000

Highway 491
Shiprock, NM 87420-0160
Phone 50536860016401

P O Box
160 Attn Business Office
Shiprock, NM 87420-0160

PO Box
Suite 160
Shiprock, NM 87420-0160

Hospital & facility affiliations

  • Northern Navajo Medical Center Hospital, Shiprock, NM, CCN 320059
  • Rhode Island Hospital Hospital, Providence, RI, CCN 410007

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
DO00523RIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lifespan Physician Group, Inc. CurrentSince Oct 1, 2018 Accepting new patients
DHHS, PHS, Naihs, Shiprock Hospital CurrentSince May 6, 2019 Accepting new patients
Kayenta Alternative Rural Hospital CurrentSince Sep 14, 2016 Accepting new patients
Lifespan Physician Group, Inc. CurrentSince Oct 1, 2018 Accepting new patients
Guam Memorial Hospital CurrentSince Jan 9, 2017 Accepting new patients
Lifespan Corporation Current Accepting new patients
DHHS, PHS, Naihs, Shiprock Hospital CurrentSince May 6, 2019 Accepting new patients
Guam Memorial Hospital CurrentSince Jan 9, 2017 Accepting new patients
Kayenta Alternative Rural Hospital Past Accepting new patients
Brown Neurology Past Accepting new patients
Nes Rhode Island, Inc. Past Accepting new patients

Locations

850 Gov Carlos G Camacho Rd
#R
Tamuning, GU 96913
Phone (671) 647-2552

850 Gov Carlos G Camacho Rd
Tamuning, GU 96913
Phone (671) 647-2555

200 High Service Ave
North Providence, RI 02904
Phone (401) 456-3000

185A High Service Ave
North Providence, RI 02904
Phone (401) 354-6050

117 Ellenfield St
Ste 101
Providence, RI 02905
Phone (401) 444-4318

593 Eddy St
Providence, RI 02903

110 Elm St
Fl 2
Providence, RI 02903

375 Wampanoag Trl
Riverside, RI 02915
Phone (401) 649-4010

Interoperability endpoints

  • Direct secure messaging: jmichaud29021@brownhealth.medalliesdirect.net

Organizations & group practices 11

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.

Hospital & facility affiliations 9

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": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533168000000",
    "number": "1992745111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 ELLENFIELD ST STE 101",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029054513",
            "telephone_number": "401-444-6779",
            "fax_number": "401-444-6912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "593 EDDY ST",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "02903",
            "telephone_number": "401-444-3985",
            "fax_number": "401-444-3986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICHAUD",
        "first_name": "JACQUELINE",
        "middle_name": "D",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-07",
        "last_updated": "2018-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "RI",
            "license": "DO00523",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9021376",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.