SOUTH COUNTY PSYCHIATRY LLC – Psychiatry Physician, NPI 1003454034
Psychiatry Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for SOUTH COUNTY PSYCHIATRY LLC
19 Halls Rd # 234
Old Lyme, CT 063711457
Phone: (959) 666-3777
Fax: (855) 268-5333
Type: Location
47 Danielson Pike
North Scituate, RI 028571892
Phone: (401) 895-7897
Fax: (401) 296-3995
Type: Location
420 SCRABBLETOWN RD STE A
NORTH KINGSTOWN, RI 028523638
Phone: (401) 268-5333
Fax: (401) 268-5330
Type: Mailing
333 Union St
New Bedford, MA 027403665
Phone: (617) 671-0728
Fax: (855) 268-5333
Type: Location
145 Pine Haven Shores Rd Ste 1191
Shelburne, VT 054827821
Phone: (401) 268-5333
Type: Location
52 Brigham St Ste 5
New Bedford, MA 027402210
Phone: (617) 671-0728
Fax: (617) 671-0728
Type: Location
1170 Pontiac Ave
Cranston, RI 029207944
Phone: (401) 895-9937
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2025-04-30
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2025-12-31 (164 days ago).
Enrollment records
4
Earliest due date
2025-12-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20200218000767 | O | Clinic/Group Practice | RI | 2025-12-31 |
| O20211217000071 | O | Clinic/Group Practice | CT | TBD |
| O20220322002314 | O | Clinic/Group Practice | MA | TBD |
| O20250430001360 | O | Clinic/Group Practice | VT | TBD |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 06371)
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