Nicholas D Iannuccilli, MD

Key facts

NPI

1992813273

Entity type

Individual (NPI type 1)

Primary specialty

Diagnostic Radiology Physician 2085R0202X

License

MD04413 (RI)

Practice address

1515 Smith St
Ste 6
North Providence, RI 02911-2947

Phone

(401) 353-1600

NPI assigned

Aug 28, 2006

Sex

Male

Sole proprietor

Yes

Organizations & group practices 3

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.

• Nicholas Iannuccilli MD Diagnostic Radiology Physician · North Providence, RI · NPI 1811179906
  NPD (past) Authorized official DIAGNOSTIC RADIOLOGY
• Bristol County Open MRI Services Inc. Diagnostic Radiology Physician · Bristol, RI · NPI 1588723886
  NPD (past) DIAGNOSTIC RADIOLOGY
• Northwestern Ri Imaging Center, LLC Radiology Clinic/Center · Johnston, RI · NPI 1881647238
  NPD (past) DIAGNOSTIC RADIOLOGY

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

HHS exclusion list flag

The National Provider Directory flags this NPI as appearing on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

Practice roles

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 16, 2016.

{
    "created_epoch": "1156723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471305600000",
    "number": "1992813273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 SMITH ST",
            "address_2": "STE 6",
            "city": "NORTH PROVIDENCE",
            "state": "RI",
            "postal_code": "029112947",
            "telephone_number": "401-353-1600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 SMITH ST",
            "address_2": "STE 6",
            "city": "NORTH PROVIDENCE",
            "state": "RI",
            "postal_code": "029112947",
            "telephone_number": "401-353-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IANNUCCILLI",
        "first_name": "NICHOLAS",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-28",
        "last_updated": "2016-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "RI",
            "license": "MD04413",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MASS WELFARE",
            "identifier": "6145612",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEIGHBORHOOD HEALTH RI GR",
            "identifier": "11237",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP RI BLUE SHIELD",
            "identifier": "3412",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "710442",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECHIP",
            "identifier": "004035",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PILGRIM",
            "identifier": "245926",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7000911",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in North Providence, RI · Diagnostic Radiology Physician in Rhode Island