| Fellowship Health Resources, Inc | |
|
24 Albion Rd Ste 210 Lincoln RI 02865-3747 | |
| (401) 642-4416 | |
| (401) 642-4453 |
| Full Name | Fellowship Health Resources, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 24 Albion Rd Ste 210, Lincoln, Rhode Island |
| Authorized Official Name and Position | Donna Busch (DIR. OF CONTRACTS AND CREDENTIALING) |
| Authorized Official Contact | 4452063028 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fellowship Health Resources, Inc 24 Albion Rd Ste 210 Lincoln RI 02865-3747 Ph: (401) 642-4416 | Fellowship Health Resources, Inc 24 Albion Rd Ste 210 Lincoln RI 02865-3747 Ph: (401) 642-4416 |
| NPI Number | 1245239680 |
|---|---|
| Provider Enumeration Date | 07/19/2005 |
| Last Update Date | 02/20/2026 |
| Certification Date | 02/20/2026 |
| Medicare PECOS PAC ID | 8224022546 |
|---|---|
| Medicare Enrollment ID | O20041014000308 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245239680 | NPI | - | NPPES |
| 1000022578 | Medicaid | DE | |
| 100814610-0013 | Medicaid | PA | |
| 100814610-0020 | Medicaid | PA | |
| NE02148 | Medicaid | RI | |
| 000656461 | Medicaid | DE | |
| 100814610-0019 | Medicaid | PA | |
| 1245239680 | Medicaid | ME | |
| 1245239680-007 | Medicaid | ME | |
| 15626000 | Medicaid | ME | |
| 004944038 | Medicaid | VA | |
| 10000656461 | Medicaid | DE | |
| 100814610-0018 | Medicaid | PA | |
| 004945662 | Medicaid | VA | |
| 100814610-0023 | Medicaid | PA | |
| NE02149 | Medicaid | RI |
| Provider Name | Naim A Memon |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1972605152 PECOS PAC ID: 8628058823 Enrollment ID: I20040720000934 |
| Provider Name | Hugh R Brenner |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1639181902 PECOS PAC ID: 1759352685 Enrollment ID: I20040804000788 |
| Provider Name | Deepak S Mahajan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1104923994 PECOS PAC ID: 4284659608 Enrollment ID: I20051013000825 |
| Provider Name | Tasneem Ali |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1215094685 PECOS PAC ID: 3870674682 Enrollment ID: I20080118000090 |
| Provider Name | Peyman Khoshgavar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1376559054 PECOS PAC ID: 2769558584 Enrollment ID: I20080902000439 |
| Provider Name | Sandra K Wiley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912911306 PECOS PAC ID: 8820165830 Enrollment ID: I20080917000202 |
| Provider Name | James J Nocks |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548203425 PECOS PAC ID: 0345318325 Enrollment ID: I20081003000293 |
| Provider Name | Lucille E Venturanza |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033269881 PECOS PAC ID: 3678634045 Enrollment ID: I20081203000548 |
| Provider Name | Ben L Boswell |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1528316122 PECOS PAC ID: 6002137197 Enrollment ID: I20150601002357 |
| Provider Name | Daisy Lara |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083081772 PECOS PAC ID: 2466760988 Enrollment ID: I20151002001907 |
| Provider Name | Lauren Eg Morris |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366775629 PECOS PAC ID: 5597092122 Enrollment ID: I20190806000665 |
| Provider Name | Jonathan M Nehrer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1124195896 PECOS PAC ID: 0941537997 Enrollment ID: I20190813003724 |
| Provider Name | Sai Yang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679119150 PECOS PAC ID: 3870914369 Enrollment ID: I20200609003090 |
| Provider Name | Jomarie J Peters |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386263705 PECOS PAC ID: 5890118863 Enrollment ID: I20200709000594 |
| Provider Name | Denise Marie Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225690225 PECOS PAC ID: 0547650863 Enrollment ID: I20211201000074 |
| Provider Name | Sudha Gutti |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295367308 PECOS PAC ID: 3779929278 Enrollment ID: I20240306003765 |
| Provider Name | Gretchen Key |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366203879 PECOS PAC ID: 1153768262 Enrollment ID: I20240326000046 |
| Provider Name | Rachel Hannah Oresky |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275945883 PECOS PAC ID: 3173063591 Enrollment ID: I20240911002960 |
| Provider Name | Elizabeth Magazzeni-rinehart |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1104552520 PECOS PAC ID: 3971941642 Enrollment ID: I20241213001151 |
| Provider Name | Elizabeth Magazzeni-rinehart |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1104552520 PECOS PAC ID: 3971941642 Enrollment ID: I20250324001526 |
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