Jack H Klie, MD

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

4568 Issued in RI

Practice address

1 Randall SQ
Suite 305
Providence, RI 02904-2709

Phone

(401) 521-0700

Fax

(401) 521-0906

NPI assigned

Nov 13, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Cardiovascular Disease (Cardiology)Also: Internal Medicine

Education

Tufts University School of Medicine, 1966

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Prospect Chartercare Sjhsri LLCGroup PAC ID 7315179314, 32 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Our Lady of Fatima Hospital Hospital, North Providence, RI, CCN 410005

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Prospect Chartercare Sjhsri, LLC

  • Cardiovascular Disease Physician
  • North Providence, RI
  • NPI 1578988572

  Cardiovascular Disease, RI

  Medicare reassignment Care Compare group NPD
• Providence Cardiology Inc

  • Cardiovascular Disease Physician
  • Providence, RI
  • NPI 1790856888

  Cardiovascular Disease, RI

  Medicare reassignment NPD Authorized official
• Providence Cardiology Testing

  • Cardiovascular Disease Physician
  • Providence, RI
  • NPI 1316017874

  Cardiovascular Disease

  NPD Authorized official
• Prospect Chartercare Sjhsri, LLC

  • General Acute Care Hospital
  • North Providence, RI
  • NPI 1871918870
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Prospect Chartercare Sjhsri, LLC

  • General Acute Care Hospital
  • North Providence, RI
  • NPI 1871918870

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1236902400000",
    "number": "1992876080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 RANDALL SQ",
            "address_2": "SUITE 305",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029042709",
            "telephone_number": "401-521-0700",
            "fax_number": "401-521-0906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 RANDALL SQ",
            "address_2": "SUITE 305",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029042709",
            "telephone_number": "401-521-0700",
            "fax_number": "401-521-0906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLIE",
        "first_name": "JACK",
        "middle_name": "H",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-13",
        "last_updated": "2009-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "RI",
            "license": "4568",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "849",
            "state": "RI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000849",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHIP",
            "identifier": "001218",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Scranton Kleinert, RN
• Sarah M. Kleinman, CNM
• Trevor Klemp, PT, DPT
• Paula Kleniewski, DPT
• Courtney Alissa Klenk, DPT
• Kristen Leigh Klimm, PA-C
• Elizabeth Klingbeil, RDN
• Petra Margarete Klinge, MD
• Adam Augustus Klipfel, M.D.
• Cindy Klipfel, MD

• All providers in Providence, RI
• Cardiovascular Disease Physician in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2009; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.