UNIVERSITY MEDICAL GROUP, INC. (NPI# 1174662738) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174662738 |
| Entity Type | Organization |
| Organization Name | UNIVERSITY MEDICAL GROUP, INC. |
| Other Organization Name | UMG - PRIMARY CARE DIVISION |
| Practice Address |
1500 Pontiac Ave Cranston RI 02920-4406 |
| Mailing Address |
5626 Oberlin Dr Suite 110 San Diego CA 92121-1705 |
| Practice Telephone | 4014648109 |
| Mailing Telephone | 8586252990 |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2013-04-08 |
| Authorized Official Name | MR. KENNY HEINE (DIRECTOR OF OPERATIONS) |
| Authorized Official Telephone | 8586252990 |
| Is Organization Subpart | Y |
| Parent Organization Name | MEDVANTX, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332900000X | Non-Pharmacy Dispensing Site | MD08630 | RI | Suppliers |
| Other Name | Type Code |
|---|---|
| UMG - Primary Care Division | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881611689 | University Medical Group, Inc. | Specialist | 5775 Sw 8th St, West Miami, FL 33144-5033 | 2006-07-16 |
| 1285775205 | University Medical Group, Inc. | Non-Pharmacy Dispensing Site | 6 Blackstone Valley Pl, 502, Lincoln, RI 02865-1179 | 2007-02-11 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | UNIVERSITY MEDICAL GROUP, INC. | 1400 Sw 5th Ave Ste 500, Portland, OR 97201 |
| Street Address |
1500 PONTIAC AVE |
| City | CRANSTON |
| State | RI |
| Zip Code | 02920-4406 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487641411 | David G Kerzer | Family Medicine | 1500 Pontiac Ave, Cranston, RI 02920-4406 | 2005-10-04 |
| 1174975445 | Roy Souaid | Internal Medicine | 1500 Pontiac Ave, Cranston, RI 02920-4486 | 2016-07-11 |
| 1881089860 | Dr. Danielle Desantis &associates | Social Worker | 1500 Pontiac Ave, Cranston, RI 02920-4486 | 2015-04-06 |
| 1225468267 | Sarah E. Ouellette | Social Worker | 1500 Pontiac Ave, Cranston, RI 02920-4486 | 2013-11-12 |
| 1770728198 | Kimberly Masterson | Counselor | 1500 Pontiac Ave, Cranston, RI 02920-4486 | 2008-12-15 |
| 1154471167 | Julie Ann Agugiaro | Counselor | 1500 Pontiac Ave, Cranston, RI 02920-4486 | 2007-01-11 |
| 1780749010 | Janet G. Marquez | Marriage & Family Therapist | 1500 Pontiac Ave, Cranston, RI 02920 | 2006-12-27 |
| 1437173572 | Sukanya Somasundar | Family Medicine | 1500 Pontiac Ave, Cranston, RI 02920-4495 | 2006-07-26 |
| 1124046511 | Alison Perry | Nurse Practitioner | 1500 Pontiac Ave, Cranston, RI 02920-4486 | 2006-07-17 |
| 1467497644 | Joel Medwin | Social Worker | 1500 Pontiac Ave, Cranston, RI 02920-4406 | 2006-06-19 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184262198 | Beacon Dental Health Ri, PC | Clinic/Center | Beacon Dental Health Ri, P.C., 1090 New London Avenue, Cranston, RI 02920 | 2019-12-20 |
| 1821642240 | Jaime L Nixon | Dietitian, Registered | 444 Meshanticut Valley Parkway, Apt 37, Cranston, RI 02920 | 2019-07-25 |
| 1164923553 | Codac Inc | Peer Specialist | 3 Regan Ct, Cranston, RI 02920 | 2018-02-22 |
| 1144673096 | Joanne Le | Optometrist | 1400 Oaklawn Ave., Cranston, RI 02920 | 2016-07-15 |
| 1053790733 | Alanna Conley | Speech-Language Pathologist | 45 Sockanosset Cross Rd Ste 100, Cranston, RI 02920 | 2015-05-27 |
| 1114322740 | Nicole Enos | Physical Therapist | 51 Sockanosset Crossroad, Cranston, RI 02920 | 2014-10-24 |
| 1841622313 | Courtney Faiith Oliver | Occupational Therapy Assistant | 150 Midway Road, Suite 173, Cranston, RI 02920 | 2013-08-06 |
| 1386086403 | Sarah Gonzalez | Marriage & Family Therapist | 105 Sockanosset Cross Rd Ste 102, Cranston, RI 02920 | 2013-07-18 |
| 1902246788 | Amanda Lee Zarriello | Physical Medicine & Rehabilitation | 10 Worthington Rd, Cranston, RI 02920 | 2013-06-26 |
| 1962742528 | Yatyee Lee | Counselor | 141 Elmwood Avenue, Cranston, RI 02920 | 2013-02-19 |
| Find all providers in zip 02920 | ||||
| Taxonomy Code | 332900000X |
| Grouping | Suppliers |
| Classification | Non-Pharmacy Dispensing Site |
| A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184767022 | Coastal Medical, Inc. | Non-Pharmacy Dispensing Site | 761 Park Ave, Cranston, RI 02910-2137 | 2007-02-14 |
| 1497897870 | Rhode Island Primary Care, Inc. | Non-Pharmacy Dispensing Site | 65 Sockanosset Cross Rd, Suite 301, Cranston, RI 02920-5536 | 2007-02-13 |
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| 1336493535 | Atmed Treatment Center, Inc | Non-Pharmacy Dispensing Site | 5750 Post Rd, East Greenwich, RI 02818-2139 | 2012-11-09 |
| 1760754923 | Richard M. Del Sesto Md Ms Ltd | Non-Pharmacy Dispensing Site | 3410 S County Trail, 303, E. Greenwich, RI 02818 | 2012-02-03 |
| 1336370691 | Provant Health Solutions, LLC | Non-Pharmacy Dispensing Site | 42 Ladd St, Suite 214, East Greenwich, RI 02818-4361 | 2009-08-05 |
| 1063684900 | Atmed Treatment Center Inc | Non-Pharmacy Dispensing Site | 1524 Atmed Avenue, Suite 122, Johnston, RI 02919 | 2008-04-01 |
| 1144304783 | Physicians of Rhode Island Enterprises Incorporated | Non-Pharmacy Dispensing Site | 10 Nate Whipple Hw 101, Cumberland, RI 02864 | 2006-10-24 |
| 1932520509 | University Internal Medicine Inc | Non-Pharmacy Dispensing Site | 407 East Ave, Suite 120, Pawtucket, RI 02860-5290 | 2013-12-26 |
| 1669800967 | Bald Hill Walk In and Primary Care | Non-Pharmacy Dispensing Site | 300 Quaker Ln, Suite 16, Warwick, RI 02886-0159 | 2013-10-23 |
| 1538474713 | University Family Medicine | Non-Pharmacy Dispensing Site | 1351 S County Trl, 301, East Greenwich, RI 02818-5079 | 2010-08-12 |
| 1447496617 | University Medicine Foundation Inc | Non-Pharmacy Dispensing Site | 50 Memorial Blvd, Newport, RI 02840-3636 | 2008-12-18 |
| 1538328570 | Rhode Island (r.i.) Cardiovascular Group Inc. | Non-Pharmacy Dispensing Site | 68 Cumberland St, 103, Woonsocket, RI 02895-3323 | 2008-06-05 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.