1568457224 NPI number — DR. JOHN GAINES MD

Table of content: DR. JOHN GAINES MD (NPI 1568457224)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568457224 NPI number — DR. JOHN GAINES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAINES
Provider First Name:
JOHN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568457224
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 DAVOL SQ
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02903-4754
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-421-4000
Provider Business Mailing Address Fax Number:
401-272-1456

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41 SANDERSON RD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
SMITHFIELD
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02917-2602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-949-0300
Provider Business Practice Location Address Fax Number:
401-369-7963
Provider Enumeration Date:
09/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD07187 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110184848 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 428-6 . This is a "BCBS OF RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: JG18500 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 202213 . This is a "BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 404476 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 04-00477 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 20850 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 60537 . This is a "HARVARD HEALTH PLAN" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 751395 . This is a "HEALTH CARE VALUE MGMT" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 050483739 . This is a "GREAT WEST HEALTH CARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 709004048 . This is a "MEDICARE GROUP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 710039601 . This is a "CIGNA" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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