Basic Information
Provider Information | |||||||||
NPI: | 1477544948 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CASSESE | ||||||||
FirstName: | JOHN | ||||||||
MiddleName: | A | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 125 METRO CENTER BOULEVARD | ||||||||
Address2: | SUITE 2000 | ||||||||
City: | WARWICK | ||||||||
State: | RI | ||||||||
PostalCode: | 028861768 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4014322520 | ||||||||
FaxNumber: | 4014538220 | ||||||||
Practice Location | |||||||||
Address1: | 125 METRO CENTER BOULEVARD | ||||||||
Address2: | SUITE 2000 | ||||||||
City: | WARWICK | ||||||||
State: | RI | ||||||||
PostalCode: | 028861768 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4014322520 | ||||||||
FaxNumber: | 4014538220 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/02/2005 | ||||||||
LastUpdateDate: | 03/20/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 10286 | RI | N |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | MD10286 | RI | Y |   | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
ID | Type | State | Issuer | Description | 406967 | 01 |   | BLUE CHIP SENIORS | OTHER | 16 00025 | 01 |   | UNITED HEALTH PLANS | OTHER | 010286 | 01 |   | BLUE SHIELD | OTHER | 300010864 | 01 |   | RAILROAD MEDICARE | OTHER | 3207056 | 01 |   | MASSMEDICAID | OTHER | 3207056 | 01 |   | HEALTHY START | OTHER | 406967 | 01 |   | BLUE CHIP | OTHER | 409791 | 01 |   | TUFTS | OTHER | 720099001 | 01 |   | CIGNA | OTHER | 000000001988 | 01 |   | NHPRI | OTHER | 003117125 | 01 |   | CT MED ASSISTANCE | OTHER | 010286 | 01 |   | FEP BLUE CROSS | OTHER | 050318025 | 01 |   | UNICARE | OTHER | 241360 | 01 |   | RIH PILGRIM | OTHER | 007008227 | 01 |   | HOSPITAL PIN | OTHER | 7008227 | 01 |   | RI MEDICAL ASSISTANCE | OTHER |