MR. MICHAEL THOMAS GAUTHIER PA-C
NPI 1235217597
Physician Assistant in Woonsocket, RI
NPI Status: Active since November 02, 2006
- Individual
- Male
- Physician Assistant
- Accepts Insurance
- PECOS Enrolled
- Medicare Quality Reporting
About MICHAEL GAUTHIER
This page provides the complete NPI Profile along with additional information for Michael Gauthier, a primary care provider established in Woonsocket, Rhode Island with a medical specialization in Physician Assistant. The healthcare provider is registered in the NPI registry with number 1235217597 assigned on November 2006. The practitioner's primary taxonomy code is 363A00000X with license number PA00427 (RI). The provider is registered as an individual and his NPI record was last updated 18 years ago.
- NPI
- 1235217597
- Provider Name
- MR. MICHAEL THOMAS GAUTHIER PA-C
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 115 CASS AVE WOONSOCKET, RI 02895
- Location Phone
- (401) 769-4100
- Mailing Address
- 15 SHEFFIELD AVE. PAWTUCKET, RI 02860
- Mailing Phone
- (401) 727-2731
- Is Sole Proprietor?
- No
- Enumeration Date
- 11-02-2006
- Last Update Date
- 07-08-2007
- Code Navigator
A primary care provider (PCP) like Michael Gauthier sees people with common medical problems. The primary care provider might be a doctor, physician assistant, nurse practitioner or clinic that are usually involved in your long-term care. A PCP might provide preventive care, treat common medical conditions, identify urgent medical problems and refer you to specialists when necessary. Primary care is usually provided in an outpatient facility but if you are admitted to a hospital your PCP may assist in your care. The most common medical conditions seen by primary care providers are: hypertension, upper respiratory tract infections, depression or anxiety, back pain, arthritis, dermatitis, diabetes, urinary tract infections, etc .
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Physician Assistant
- Taxonomy Code
- 363A00000X
- Type
- Physician Assistants & Advanced Practice Nursing Providers
- License No.
- PA00427
- License State
- RI
- Taxonomy Description
- A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Anthem Bronze Access Blue New England HMO 5000/10%/8000 w/HSA - HMO
- Anthem Bronze Access Blue New England HMO 5000/20%/8000 w/HSA - HMO
- Anthem Bronze Access Blue New England HMO 6500/30%/9200 Value - HMO
- Anthem Bronze Access Blue New England HMO 7000/50%/8000 w/HSA - HMO
- Anthem Bronze Access Blue New England HMO 8500/50%/9200 - HMO
- Anthem Gold Access Blue New England HMO 1000/20%/7500 - HMO
- Anthem Gold Access Blue New England HMO 2000/0%/6500 RxD - HMO
- Anthem Gold Access Blue New England HMO 2000/10%/4600 w/HSA - HMO
- Anthem Gold Access Blue New England HMO 2000/10%/7500 - HMO
- Anthem Gold Access Blue New England HMO 2000/20%/4600 w/HSA - HMO
- Anthem Gold Access Blue New England HMO 3000/0%/5500 RxD - HMO
- Anthem Gold Access Blue New England HMO 500/25%/7000 - HMO
- Anthem Platinum Access Blue New England HMO 250/10%/3500 - HMO
- Anthem Silver Access Blue New England HMO 2000/30%/9000 Value - HMO
- Anthem Silver Access Blue New England HMO 3000/20%/8500 - HMO
- Anthem Silver Access Blue New England HMO 3000/30%/9000 Value - HMO
- Anthem Silver Access Blue New England HMO 3500/20%/7250 w/HSA - HMO
- Anthem Silver Access Blue New England HMO 4000/0%/8500 - HMO
- Anthem Silver Access Blue New England HMO 4000/0%/8500 RxD - HMO
- Anthem Silver Access Blue New England HMO 4000/10%/7250 w/HSA - HMO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Medicare Participation & PECOS Enrollment Status
Michael Gauthier is enrolled in PECOS and is eligible to order or refer health care services for Medicare patients. The provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Is the provider registered in PECOS? Yes
Eligible to Order or Refer Part B Clinical Laboratory and Imaging: Yes
Eligible to Order or Refer Durable Medical Equipment (DMEPOS): Yes
Eligible to Order or Refer a Home Health Agency (HHA): Yes
Eligible to Order or Refer Power Mobility Devices: Yes
Areas of Expertise
The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.
Emergency department visit for problem of high severity
Emergency department visit for problem of mild to moderate severity
Emergency department visit for problem of moderate severity
Follow-up observation care per day, typically 15 minutes
Follow-up observation care per day, typically 25 minutes
Hospital observation care on day of discharge
Initial hospital observation care per day, typically 70 minutes
An emergency department visit for a high-severity issue means you're experiencing a serious health problem that needs immediate attention. This could be a severe injury, serious illness, or life-threatening condition. Medical professionals will provide urgent care to stabilize your condition.
This service was performed 32 times for 32 patientsAn emergency department visit for a mild to moderate issue is when you seek immediate medical attention for a non-life-threatening condition. This could include minor injuries, moderate pain, or illnesses like the flu. During the visit, healthcare professionals assess your condition, provide treatment, and may recommend follow-up care.
This service was performed 31 times for 30 patientsAn emergency department visit for a problem of moderate severity involves immediate medical attention for issues like minor fractures, burns, or high fever. The healthcare team will assess your condition, provide necessary treatment, and may suggest further tests or admission if required.
This service was performed 124 times for 120 patientsFollow-up observation care is a daily check-up service where your health is monitored for about 15 minutes. This routine observation helps track your recovery progress or any changes in your condition. It's a crucial part of ensuring your health and well-being.
This service was performed 33 times for 24 patientsFollow-up observation care is a daily service where your health progress is monitored for about 25 minutes. It's a routine check to ensure your treatment is effective and to adjust if necessary. It's a crucial part of your healthcare journey.
This service was performed 17 times for 11 patientsHospital observation care on the day of discharge involves monitoring your health status to ensure stability before you leave. This includes assessing vital signs, response to treatment, and readiness for home care or rehabilitation.
This service was performed 36 times for 35 patientsThis service involves a healthcare professional closely monitoring your health condition during your hospital stay. It typically lasts for about 70 minutes each day. This helps in timely detection of any changes in your health, allowing for immediate response and treatment.
This service was performed 37 times for 36 patientsPhysician Visit Costs
The pricing information below displays the copayment minimum, maximum and average amount that patients under Medicare are charged when visiting this provider as a new or established patient. Please keep in mind that these prices are just for reference purposes, and the actual prices charged by the provider might be different.
For patients covered under private health plans the prices below are also useful as healthcare pricing for private insurance is usually established as a function of Medicare prices. Private insurance covered patients should check their individual plans to determine the exact pricing.
The prices below reflect the costs for new and established patients in the 02895 ZIP code area.
New Patients Visit Costs *
The most utilized procedure code for new patients office visits is 99203
- Average New Patient Price $90.48
- Minimum New Patient Price $58.57
- Maximum New Patient Price $177.03
- Average New Patient Copayment $22.62
- Minimum New Patient Copayment $14.64
- Maximum New Patient Copayment $44.25
Established Patients Visit Costs *
The most utilized procedure code for established patients office visits is 99213
- Average Established Patient Price $72.93
- Minimum Established Patient Price $18.92
- Maximum Established Patient Price $144.38
- Average Established Patient Copayment $18.23
- Minimum Established Patient Copayment $4.73
- Maximum Established Patient Copayment $36.09
* The physician office visit costs information is generated by statistical analysis of similar providers in the same geographical area. The pricing information above IS NOT the amount charged by this provider.
Quality Reporting
The provider participated in CMS Quality Payment Program. The Quality Payment Program aims to improve population health, reduce costs and improve the care received by Medicare beneficiaries. The following quality measures meet Medicare's statistical reporting standards. Not all providers report the same information, because not all providers give the same services to patients. The quality information is just a snapshot of some the care providers give to their patients. Reporting more or less information is not a reflection of quality.
| Quality Measure | Performance | Number of Patients |
|---|---|---|
| Implementation of improvements that contribute to more timely communication of test results | Yes | N/A |
| Timely communication of test results defined as timely identification of abnormal test results with timely follow-up. | ||
| Measurement and Improvement at the Practice and Panel Level | Yes | N/A |
| Measure and improve quality at the practice and panel level, such as the American Board of Orthopaedic Surgery (ABOS) Physician Scorecards, that could include one or more of the following: • Regularly review measures of quality, utilization, patient satisfaction and other measures that may be useful at the practice level and at the level of the care team or MIPS eligible clinician or group (panel); and/or • Use relevant data sources to create benchmarks and goals for performance at the practice level and panel level. | ||
| Provide 24/7 Access to MIPS Eligible Clinicians or Groups Who Have Real-Time Access to Patient's Medical Record | Yes | N/A |
| • Provide 24/7 access to MIPS eligible clinicians, groups, or care teams for advice about urgent and emergent care (e.g., MIPS eligible clinician and care team access to medical record, cross-coverage with access to medical record, or protocol-driven nurse line with access to medical record) that could include one or more of the following: • Expanded hours in evenings and weekends with access to the patient medical record (e.g., coordinate with small practices to provide alternate hour office visits and urgent care); • Use of alternatives to increase access to care team by MIPS eligible clinicians and groups, such as e-visits, phone visits, group visits, home visits and alternate locations (e.g., senior centers and assisted living centers); and/or Provision of same-day or next-day access to a consistent MIPS eligible clinician, group or care team when needed for urgent care or transition management. | ||
| Regularly assess the patient experience of care through surveys, advisory councils and/or other mechanisms. | Yes | N/A |
| Regularly assess the patient experience of care through surveys, advisory councils and/or other mechanisms. | ||
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 2 | 3 | 5 | 2 | 1 | 7 | 5 | 9 | 7 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 2 | 6 | 5 | 4 | 1 | 14 | 5 | 18 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 2 + 6 + 5 + 4 + 1 + 1 + 4 + 5 + 1 + 8 + 24 = 63 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 70 - 63 = 7 | 7 | ||||||||
The NPI number 1235217597 is valid because the calculated check digit 7 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 20 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1114900024 | GLENN G. FORT MD Individual | Internal Medicine | 115 CASS AVE LANDMARK MEDICAL CENTER WOONSOCKET, RI 02895 (401) 766-3428 |
| 1043297112 | LANDMARK MEDICAL CENTER Organization | Internal Medicine (Cardiovascular Disease) | 115 CASS AVE WOONSOCKET, RI 02895 (401) 769-4100 |
| 1386690576 | CHRISTOPHER M QUINN Individual | Physical Medicine & Rehabilitation | 115 CASS AVE WOONSOCKET, RI 02895 (401) 769-4100 |
| 1942241088 | DR. GEORGE J SHERVANICK II D.O. Individual | Emergency Medicine | 115 CASS AVE WOONSOCKET, RI 02895 (401) 769-4100 |
| 1952332041 | DR. AHMED NADEEM MD Individual | Internal Medicine (Hematology & Oncology) | 115 CASS AVE WOONSOCKET, RI 02895 (401) 767-1541 |
| 1962437871 | JEREMY ERIC STEINBERG P.A. Individual | Physician Assistant | 115 CASS AVE WOONSOCKET, RI 02895 (401) 769-4100 |
| 1902819402 | DENNIS L PRIOLO MD Individual | Radiology (Diagnostic Radiology) | 115 CASS AVE HOSPITAL BASED - LANDMARK MEDICAL CENTER WOONSOCKET, RI 02895 (401) 769-4100 |
| 1073628673 | MR. GERARD FRANCIS DOUGHERTY P.A. Individual | Physician Assistant (Medical) | 115 CASS AVE WOONSOCKET, RI 02895 (401) 769-4100 |
| 1851407746 | MR. DAVID C. ANDERSON CRNA Individual | Nurse Anesthetist, Certified Registered | 115 CASS AVE NORTHERN RHODE ISLAND ANESTHESIA ASSOCIATES, PC WOONSOCKET, RI 02895 (401) 769-4100 |
| 1003993072 | CHARLES J KIM MD Individual | Anesthesiology | 115 CASS AVE WOONSOCKET, RI 02895 (401) 769-4100 |
| 1578608667 | BRADLEY D HEERMANN MD Individual | Emergency Medicine (Emergency Medical Services) | 115 CASS AVE WOONSOCKET, RI 02895 (401) 769-4100 |
| 1750500757 | MRS. KARIN LYNN O'ROURKE RNP Individual | Nurse Practitioner (Family) | 115 CASS AVE WOONSOCKET, RI 02895 (401) 769-4100 |
| 1841477361 | PATRICK ROGER LEVESQUE, MD Organization | Internal Medicine | 115 CASS AVE WOONSOCKET, RI 02895 (401) 769-4100 |
| 1972754562 | MRS. DEBRA LEE SERVELLO RNP Individual | Nurse Practitioner (Acute Care) | 115 CASS AVE WOONSOCKET, RI 02895 (401) 769-4100 |
| 1730403437 | MRS. SUZANNE LEIGH MACDONALD RD, LDN Individual | Dietitian, Registered | 115 CASS AVE LANDMARK MEDICAL CENTER - NUTRITION SERVICES WOONSOCKET, RI 02895 (401) 769-4100 |
| 1194005215 | Q MED INC Organization | Physical Medicine & Rehabilitation | 115 CASS AVE WOONSOCKET, RI 02895 (401) 769-4100 |
| 1992073308 | BLACKSTONE MEDICAL CENTER, INC. Organization | Psychiatric Unit | 115 CASS AVE WOONSOCKET, RI 02895 (401) 769-4100 |
| 1447528856 | BLACKSTONE MEDICAL CENTER, INC. Organization | Internal Medicine (Cardiovascular Disease) | 115 CASS AVE WOONSOCKET, RI 02895 (401) 769-4100 |
| 1538437942 | BLACKSTONE MEDICAL CENTER, INC. Organization | General Acute Care Hospital | 115 CASS AVE WOONSOCKET, RI 02895 (401) 769-4100 |
| 1477817245 | MRS. CHERIE SODERBOM RD Individual | Dietitian, Registered | 115 CASS AVE WOONSOCKET, RI 02895 (401) 769-4100 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1235217597, enumerated in the NPI registry as an "individual" on November 02, 2006
The provider is located at 115 Cass Ave Woonsocket, Ri 02895 and the phone number is (401) 769-4100
The provider's speciality is Physician Assistant with taxonomy code 363A00000X
The provider might be accepting Accepts: Anthem Blue Cross and Blue Shield. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
Yes, as of June 20, 2025 the provider is registered in PECOS and is eligible to order health care services or supplies for Medicare patients. If you are a beneficiary the provider is eligible to order or refer: Part B Clinical Laboratory and Imaging, Durable Medical Equipment (DME), a Home Health Agency (HHA) and Power Mobility Devices.
Medicare beneficiaries should expect a typical cost of $90.48 with an average copayment of $22.62 for new patient appointments. Established patients should expect a typical charge of $72.93 and an average copayment of 18.23. Please review your insurance plan or contact the provider directly to determine your specific costs.
The most common procedures or services performed by this practitioner are: Emergency department visit for problem of high severity, Emergency department visit for problem of mild to moderate severity, Emergency department visit for problem of moderate severity, Follow-up observation care per day, typically 15 minutes, Follow-up observation care per day, typically 25 minutes, Hospital observation care on day of discharge and Initial hospital observation care per day, typically 70 minutes.
This NPI record was last updated on November 02, 2006. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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