JASON CHARLES XYNELLIS (NPI# 1952501942) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1952501942 |
Entity Type | Individual |
Full Name | JASON CHARLES XYNELLIS |
Credential | PA-C |
Practice Address |
1195 N Main St Providence RI 02904-1824 |
Practice Telephone | 4013318555 |
Mailing Telephone | 4013318555 |
Enumeration Date | 2007-07-19 |
Last Update Date | 2012-11-30 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA00501 | RI | Physician Assistants & Advanced Practice Nursing Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
RI | JX84601 | 05 | |
RI | MEDICARE PTAN | 0021338 | 01 |
Street Address |
1195 N MAIN ST |
City | PROVIDENCE |
State | RI |
Zip Code | 02904-1824 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1790744381 | Ian Paul Krouson | Physician Assistant | 1195 N Main St, Providence, RI 02904-1824 | 2006-03-22 |
1730663287 | Lisa S Bailey | Physician Assistant | 1195 N Main St, Providence, RI 02904-1824 | 2018-09-20 |
1700323490 | Sean Bennett Eden | Physician Assistant | 1195 N Main St, Fl 2, Providence, RI 02904-1824 | 2017-01-19 |
1558816330 | East Side Primary Care Providence LLC | Internal Medicine | 1195 N Main St, Providence, RI 02904-1824 | 2016-08-22 |
1235305871 | Agape Primary Care and Laser Center LLC | Dermatology | 1195 N Main St, Providence, RI 02904-1824 | 2008-05-04 |
1558531467 | East Side Urgent Care LLC | Clinic/Center | 1195 N Main St, Providence, RI 02904-1824 | 2008-03-06 |
1437224763 | Michael Stempek | Physician Assistant | 1195 N Main St, Providence, RI 02904-1824 | 2006-11-21 |
1639168198 | Frederick Salvatore Crisafulli | Internal Medicine | 1195 N Main St, Providence, RI 02904-1824 | 2005-10-18 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1144792383 | Lifespan Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 180 Corliss Street, Suite A, Providence, RI 02904 | 2018-12-28 |
1780168229 | Beth M. Kalunian | Social Worker | 480 Charles Street, Providence, RI 02904 | 2018-09-20 |
1588161608 | Michael P. Johnson, Md, Inc | Internal Medicine | 148 W River St Ste 22b, Providence, RI 02904 | 2018-04-06 |
1780045948 | Fred Saccoccio | Pharmacist | 15 Smithfield Road, No Providence, RI 02904 | 2016-03-16 |
1699148999 | Latin Adult Day Health Care Center | Clinic/Center | 665 Charles Street, Providence, RI 02904 | 2015-11-09 |
1144639956 | Dina P Toolin | Occupational Therapist | 195 Collyer St. 3rd Floor, University Medical Center/miriam Hospital Outpatient, Providence, RI 02904 | 2014-08-06 |
1801208798 | Seth Clark | Internal Medicine | 200 Corliss St, Providence, RI 02904 | 2014-05-27 |
1134554645 | Molly Elizabeth Smith | Physical Therapist | 1405 Douglas Ave, North Providence, RI 02904 | 2013-09-04 |
1336408723 | Emad Awa | Pediatrics | 1 Randall Sq Ste 404, Providence, RI 02904 | 2012-05-07 |
1598036790 | Joseph F. Osmanski, Od, Inc | Optometrist | 1971 Mineral Spring Avenue, N. Providence, RI 02904 | 2012-01-19 |
Find all providers in zip 02904 |
Taxonomy Code | 363AM0700X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Physician Assistant |
Specialization | Medical |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1962962589 | Delaney Horsley | Physician Assistant | 472 W Fountain St Apt 1, Providence, RI 02903-3570 | 2019-03-20 |
1346698024 | Samantha Lea Colli | Physician Assistant | 100 Dudley St Fl 3, Providence, RI 02905 | 2016-06-02 |
1548204399 | Jeannette Mary Doyle-gay | Physician Assistant | 164 Summitt Ave, Room C70, The Miriam Hospital, Providence, RI 02906 | 2006-06-15 |
1790744381 | Ian Paul Krouson | Physician Assistant | 1195 N Main St, Providence, RI 02904-1824 | 2006-03-22 |
1457328221 | Richard A. Hernandez | Physician Assistant | 164 Summit Ave # C70, Providence, RI 02906-2853 | 2006-03-01 |
1801889787 | Paul Mallari | Physician Assistant | 49 Seekonk St, Suite 3, Providence, RI 02906-5176 | 2005-08-25 |
1558369512 | Josephine Salhab | Physician Assistant | 164 Summit Ave, Rm C70, Providence, RI 02906-2853 | 2005-07-13 |
1528065430 | Sandra M Jamieson | Physician Assistant | 593 Eddy Street, Grad Dorms, Providence, RI 02903 | 2005-07-07 |
1518962034 | Patricia A Trafford | Physician Assistant | 790 N Main St, Providence, RI 02904-5706 | 2005-06-21 |
1336144856 | Arya Biswas | Physician Assistant | 280 Melrose St, Providence, RI 02907-2152 | 2005-06-21 |
Find all providers in PROVIDENCE |
City | PROVIDENCE |
Zip Code | 02904 |
Please comment or provide details below to improve the information on JASON CHARLES XYNELLIS.
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.