1. Home
  2. Directory
  3. Rhode Island
  4. North Providence
  5. Pediatrics
  6. NPI Profile

SANTIAGO MEDICAL GROUP, INC.
NPI 1790830339
Pediatrics - Adolescent Medicine in North Providence, RI

Active since January 24, 2007CLIA 41D1008389 · Waiver
967 MINERAL SPRING AVENUE, NORTH PROVIDENCE, RI 02904(401) 312-0444 Get Directions Write a Review

NPPES record last updated: July 15, 2009. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Santiago Medical Group, Inc. NPPES

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

SANTIAGO MEDICAL GROUP, INC. (NPI 1790830339) is a healthcare organization registered as an adolescent medicine in North Providence, Rhode Island and active in the NPI registry since January 2007. The organization holds a CLIA Waiver certificate valid through January 20, 2027 and lists Miguel A Fuentes, President, as its authorized official.

NPPES Registry Identity

NPI1790830339
Entity TypeOrganization
Primary Taxonomy2080A0000X
Legal Business NameSANTIAGO MEDICAL GROUP, INC.
Location Address967 MINERAL SPRING AVENUENorth Providence, RI 02904-4934
Mailing Address967 Mineral Spring AveNorth Providence, RI 02904-4934 · (401) 312-0444
Phone(401) 312-0444
Organization SubpartNo
Authorized OfficialMiguel A FuentesPresident · (401) 312-0444
Enumeration DateJanuary 24, 2007
Last NPPES UpdateJuly 15, 2009
✔ NPI 1790830339 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatrics · Adolescent MedicineAllopathic & Osteopathic Physicians
Taxonomy Code2080A0000X
Definition
A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.
967 MINERAL SPRING AVENUE, North Providence, RI 02904
Open in Google Maps ↗

Other Identifiers 1

Medicare ID-Type UnspecifiedMS47209RI

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

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 41D1008389

Santiago Medical Group, Inc · North Providence, RI
Active · expires Jan 20, 2027
CLIA Number41D1008389
Laboratory TypePhysician Office
Certificate Effective DateJanuary 21, 2025
Certificate Expiration DateJanuary 20, 2027
Laboratory DirectorTeresa L. Jeraldo
Laboratory Phone(401) 312-0444
Laboratory LocationSantiago Medical Group, Inc967 Mineral Spring Avenue, North Providence, RI 02904
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 Santiago Medical Group, Inc.'s NPI number?

The NPI number for Santiago Medical Group, Inc. is 1790830339. It was assigned to this organization in the NPPES registry on January 24, 2007.

Where is Santiago Medical Group, Inc. located?

Santiago Medical Group, Inc. is located at 967 Mineral Spring Avenue, North Providence, RI 02904. The listed phone number is (401) 312-0444.

What is Santiago Medical Group, Inc.'s specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Adolescent Medicine, with taxonomy code 2080A0000X.

Does Santiago Medical Group, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 41D1008389) is associated with this NPI, valid through January 20, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Santiago Medical Group, Inc. was last updated on July 15, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years 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.