SCMG Infectious Disease & Lyme Clinic – Infectious Disease Physician, NPI 1386905313
Infectious Disease Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for SCMG Infectious Disease & Lyme Clinic
100 KENYON AVE
WAKEFIELD, RI 028794216
Phone: (401) 788-3929
Fax: (401) 788-3939
Type: Location
3461 S County Trl Ste 301
East Greenwich, RI 028181463
Phone: (401) 471-6285
Fax: (401) 471-6284
Type: Location
268 Post Rd
Westerly, RI 028916600
Phone: (401) 471-6285
Fax: (401) 471-6284
Type: Location
120 Centerville Rd Ste 2
Warwick, RI 028864336
Phone: (401) 789-8543
Fax: (401) 782-8766
Type: Location
100 Kenyon Ave
Wakefield, RI 028794216
Phone: (401) 788-3929
Fax: (401) 788-3939
Type: Location
14 WOODRUFF AVE STE 1
NARRAGANSETT, RI 028823467
Phone: (401) 789-8543
Fax: (401) 782-8766
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: 2012-10-11
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-08-31 (1015 days ago).
Enrollment records
1
Earliest due date
2023-08-31
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 |
|---|---|---|---|---|
| O20121011000237 | O | Clinic/Group Practice | RI | 2023-08-31 |
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 02879)
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