Jack R Bevivino (NPI# 1780705707, PAC ID# 1759576929) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PLASTIC AND RECONSTRUCTIVE SURGERY.
| Nation Provider ID (NPI) | 1780705707 |
| PAC ID by PECOS | 1759576929 |
| Professional Enrollment ID | I20101112000952 |
| Full Name | Jack R Bevivino |
| Address |
120 Dudley St Suite 201 Providence RI 02905-2431 |
| Phone Number | 4015219290 |
| Gender | M |
| Medical School | GEORGETOWN UNIVERSITY OF MEDICINE |
| Graduation Year | 1976 |
| Primary Specialty | PLASTIC AND RECONSTRUCTIVE SURGERY |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 410007 | RHODE ISLAND HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 120 Dudley St, Suite 201, Providence, RI 02905-2431 | 4015219290 |
| Street Address |
120 DUDLEY ST SUITE 201 |
| City | PROVIDENCE |
| State | RI |
| Zip | 02905-2431 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Yoash R Enzer | Ophthalmology | 120 Dudley St, Suite 104, Providence, RI 02905-2431 | |
| Philip R Rizzuto | Ophthalmology | 120 Dudley St, Suite 301, Providence, RI 02905-2429 | |
| Robert Janigian Jr. | Ophthalmology | Robert H. Janigian Jr. Md LLC | 120 Dudley St, Suite 303, Providence, RI 02905-2429 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Clarissa D. Lewis | Optometry | The Providence Community Health Centers Inc. | 335 Prairie Ave, Fl 2, Providence, RI 02905-1924 |
| Angel M. Eads | Family Medicine | The Providence Community Health Centers Inc. | 355 Prairie Ave, Providence, RI 02905-1928 |
| Sandrine O Guilherme | Clinical Social Worker | The Providence Center Inc | 355 Prairie Ave, Providence, RI 02905-1928 |
| Katherine Williams | Family Medicine | The Providence Community Health Centers Inc. | 355 Prairie Ave, Providence, RI 02905-1928 |
| Luis A Ferreira | Clinical Social Worker | The Providence Center Inc | 355 Prairie Ave, Providence, RI 02905-1928 |
| Andrew Saal | Family Medicine | The Providence Community Health Centers Inc. | 355 Prairie Ave, Providence, RI 02905-1928 |
| Lauren E Stewart | Obstetrics/gynecology | The Providence Community Health Centers Inc. | 355 Prairie Ave, Providence, RI 02905-1928 |
| Tenesha R Lisbon | Nurse Practitioner | The Providence Community Health Centers Inc. | 355 Prairie Ave, Providence, RI 02905-1928 |
| Elaine K Parker Williams | Nurse Practitioner | The Providence Community Health Centers Inc. | 355 Prairie Ave, Providence, RI 02905-1928 |
| Carla Martin | Internal Medicine | The Providence Community Health Centers Inc. | 355 Prairie Ave, Providence, RI 02905-1928 |
| Find all physicians in zip 02905 | |||
| City | PROVIDENCE |
| Zip Code | 02905 |
| Specialty | PLASTIC AND RECONSTRUCTIVE SURGERY |
| City + Specialty | PROVIDENCE + PLASTIC AND RECONSTRUCTIVE SURGERY |
Please comment or provide details below to improve the information on Jack R Bevivino.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.