PROVIDENCE INTERVENTIONAL ASSOCIATES II LLC
NPI 1306123476
Radiology - Vascular & Interventional Radiology in Providence, RI

Q: What is Providence Interventional Associates II LLC's specialty?

The primary specialty registered for this NPI is Radiology, specializing in Vascular & Interventional Radiology, with taxonomy code 2085R0204X.

Active since November 03, 2011CLIA 41D2154673 · Waiver

100 HIGHLAND AVE STE 100, PROVIDENCE, RI 02906(401) 277-9729(401) 277-9730 Get Directions Write a Review

NPPES record last updated: June 13, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jun 13, 2025, Jul 11, 2023, May 9, 2023 and 4 more (7 updates tracked since 2018).

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About Providence Interventional Associates Ii Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROVIDENCE INTERVENTIONAL ASSOCIATES II LLC (NPI 1306123476) is a healthcare organization registered as a vascular & interventional radiology in Providence, Rhode Island and active in the NPI registry since November 2011. The organization holds a CLIA Waiver certificate valid through September 17, 2028 and lists Jonah Licht, Owner, as its authorized official.

NPPES Registry Identity

NPI1306123476

Entity TypeOrganization

Primary Taxonomy2085R0204X

Legal Business NamePROVIDENCE INTERVENTIONAL ASSOCIATES II LLC

Location Address100 HIGHLAND AVE STE 100Providence, RI 02906-2740

Mailing Address100 Highland Ave Ste 100Providence, RI 02906-2740 · (401) 277-9729 · Fax (401) 277-9730

Phone(401) 277-9729

Fax(401) 277-9730

Organization SubpartNo

Authorized OfficialJonah LichtOwner · (401) 277-9729

Enumeration DateNovember 3, 2011

Last NPPES UpdateJune 13, 20257 updates tracked since enumeration

NPPES CertifiedJune 13, 2025

✔ NPI 1306123476 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyRadiology · Vascular & Interventional RadiologyAllopathic & Osteopathic Physicians

Taxonomy Code2085R0204X

Definition

A radiologist who diagnoses and treats diseases by various radiologic imaging modalities. These include fluoroscopy, digital radiography, computed tomography, sonography and magnetic resonance imaging.

Also ListedInternal Medicine · NephrologyTaxonomy 207RN0300X

100 HIGHLAND AVE STE 100, Providence, RI 02906

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Other Identifiers 1

MedicaidPR86788RI

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Providence Interventional Associates Ii Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Providence Interventional Associates II LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Jonah Licht, MD

Nephrology

NPI 1134192891

100 HIGHLAND AVE
Providence, RI 02906

(401) 277-9729

✔ PECOSSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 41D2154673

Providence Interventional Associates II, LLC · Providence, RI

Active · expires Sep 17, 2028

CLIA Number41D2154673

Laboratory TypePhysician Office

Certificate Effective DateSeptember 18, 2026

Certificate Expiration DateSeptember 17, 2028

Laboratory DirectorJonah M. Licht MD

Laboratory Phone(401) 277-9729

Laboratory LocationProvidence Interventional Associates II, LLC100 Highland Ave Ste 100, Providence, RI 02906

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Providence Interventional Associates II LLC's NPI number?

The NPI number for Providence Interventional Associates II LLC is 1306123476. It was assigned to this organization in the NPPES registry on November 3, 2011.

Where is Providence Interventional Associates II LLC located?

Providence Interventional Associates II LLC is located at 100 Highland Ave Ste 100, Providence, RI 02906. The listed phone number is (401) 277-9729.

What is Providence Interventional Associates II LLC's specialty?

The primary specialty registered for this NPI is Radiology, specializing in Vascular & Interventional Radiology, with taxonomy code 2085R0204X.

Is Providence Interventional Associates II LLC enrolled in Medicare?

Yes. Providence Interventional Associates II LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Providence Interventional Associates II LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nephrology) reassigns their Medicare billing to Providence Interventional Associates II LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Providence Interventional Associates II LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 41D2154673) is associated with this NPI, valid through September 17, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Providence Interventional Associates II LLC was last updated on June 13, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.