✓ Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant (363A00000X) ✓ HHS OIG Screened Clear 🩺 Entity Type 1 (Individual)

LAUREEN MALATESTA BERKOWITZ, PA-C (NPI #1104110030)

Physician Assistant • PROVIDENCE, RI • Status: Active Federal Registration

⚙️ JSON API
CMS-1500 Box 24J / 33a • NPI
1104110030
Type 1 Individual Rendering/Ordering
HIPAA NUCC Taxonomy • CMS Code
363A00000X (CMS 97)
Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant
Box 32 Service Location & ZIP+4
1125 N MAIN ST, PROVIDENCE, RI, 02904-5739
✓ 9-Digit EDI 837 ZIP+4 (02904-5739)
Practice Phone & Referral Fax
Fax: (401) 793-7401
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1104110030 (LAUREEN MALATESTA BERKOWITZ, PA-C) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number1104110030 (NPI-1 Individual Practitioner)
Provider / Legal NameLAUREEN MALATESTA BERKOWITZ, PA-C
Plain-English SpecialtyLicensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant
NUCC Code: 363A00000X (Physician Assistant)
Certifying / Licensing BodyState Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address1125 N MAIN ST, PROVIDENCE, RI, 02904-5739
Practice Telephone / FaxTel: (401) 793-2928 | Fax: (401) 793-7401
Administrative Mailing Address6 PIONEER CIR, SHARON, MA, 02067-2744
Enumeration & Last SyncEnumerated: 2011-06-08 | CMS Record Updated: 2020-06-17

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

1125 N MAIN ST, PROVIDENCE, RI, 02904-5739

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Plain-English Taxonomy & CMS Crosswalk (363A00000X)

What Does Taxonomy Code 363A00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363A00000X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 97 (Physician Assistant)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Physician Assistant for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (LAUREEN MALATESTA BERKOWITZ, PA-C)

Typical CPT / Diagnostic Procedures:
  • Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
  • Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
  • Preventive Screening, Patient Counseling & Multidisciplinary Referral
Common Therapeutic Classes:
  • Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English DescriptionState License & Primary Status
363A00000X — Physician Assistant
Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant
State: RI | License: PA00801 | Primary: Yes (Primary)
Medical Billing, RCM & Hospital Credentialing Teams:
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