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  5. THE MEDICAL GROUP OF RHODE ISLAND, INC.

THE MEDICAL GROUP OF RHODE ISLAND, INC.

Company Details

Name: THE MEDICAL GROUP OF RHODE ISLAND, INC.
Jurisdiction: Rhode Island
Entity type: Professional Service Corporation
Status: Activ
Date of Organization in Rhode Island: 24 Sep 1979 (45 years ago)
Identification Number: 000002279
ZIP code: 02888
County: Kent County
Principal Address: 1030 WARWICK AVENUE, WARWICK, RI, 02888, USA
Purpose: RENDERING PROFESSIONAL MEDICAL SERVICES
NAICS: 621111 - Offices of Physicians (except Mental Health Specialists)
Historical names: Dudley E. Bennett, D.O., Ltd.

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1255418729 2006-11-01 2023-03-07 76 VERDANT DR, CRANSTON, RI, 029201043, US 37 WASHINGTON ST, WEST WARWICK, RI, 028934927, US

Contacts
Phone +1 401-828-5624
Phone +1 401-821-4707
Fax 4018218270

Authorized person
Name MS. LUANN M KELLY
Role NURSE PRACTITIONER
Phone 4014676257

Taxonomy
Taxonomy Code 174400000X - Specialist
Is Primary Yes

Other Provider Identifiers
Issuer LICENSE NUMBER
Number NPP37282
State RI

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
THE MEDICAL GROUP OF RHODE ISLAND, INC. PROFIT SHARING PLAN 2023 050383917 2024-08-20 THE MEDICAL GROUP OF RHODE ISLAND, INC. 14
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1976-10-01
Business code 621111
Sponsor’s telephone number 4014676210
Plan sponsor’s address 95 SEAWYNDS DRIVE, NORTH KINGSTOWN, RI, 02852
THE MEDICAL GROUP OF RHODE ISLAND, INC. PROFIT SHARING PLAN 2022 050383917 2023-11-22 THE MEDICAL GROUP OF RHODE ISLAND, INC. 28
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1976-10-01
Business code 621111
Sponsor’s telephone number 4014676210
Plan sponsor’s address 95 SEAWYNDS DRIVE, NORTH KINGSTOWN, RI, 02852
THE MEDICAL GROUP OF RHODE ISLAND, INC. PROFIT SHARING PLAN 2021 050383917 2022-12-01 THE MEDICAL GROUP OF RHODE ISLAND, INC. 35
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1976-10-01
Business code 621111
Sponsor’s telephone number 4014676210
Plan sponsor’s address 95 SEAWYNDS DRIVE, NORTH KINGSTOWN, RI, 02852
THE MEDICAL GROUP OF RHODE ISLAND, INC. PROFIT SHARING PLAN 2020 050383917 2021-11-09 THE MEDICAL GROUP OF RHODE ISLAND, INC. 40
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1976-10-01
Business code 621111
Sponsor’s telephone number 4014676210
Plan sponsor’s address 1050 WARWICK AVENUE, WARWICK, RI, 028883655
THE MEDICAL GROUP OF RHODE ISLAND, INC. PROFIT SHARING PLAN 2019 050383917 2020-11-02 THE MEDICAL GROUP OF RHODE ISLAND, INC. 41
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1976-10-01
Business code 621111
Sponsor’s telephone number 4014676210
Plan sponsor’s address 1050 WARWICK AVENUE, WARWICK, RI, 028883655
THE MEDICAL GROUP OF RHODE ISLAND, INC. PROFIT SHARING PLAN 2018 050383917 2019-11-13 THE MEDICAL GROUP OF RHODE ISLAND, INC. 42
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1976-10-01
Business code 621111
Sponsor’s telephone number 4014676210
Plan sponsor’s address 1050 WARWICK AVENUE, WARWICK, RI, 028883655
THE MEDICAL GROUP OF RHODE ISLAND, INC. PROFIT SHARING PLAN 2017 050383917 2018-10-29 THE MEDICAL GROUP OF RHODE ISLAND, INC. 39
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1976-10-01
Business code 621111
Sponsor’s telephone number 4014676210
Plan sponsor’s address 1050 WARWICK AVENUE, WARWICK, RI, 028883655
THE MEDICAL GROUP OF RHODE ISLAND, INC. PROFIT SHARING PLAN 2016 050383917 2017-10-31 THE MEDICAL GROUP OF RHODE ISLAND, INC. 40
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1976-10-01
Business code 621111
Sponsor’s telephone number 4014676210
Plan sponsor’s address 1050 WARWICK AVENUE, WARWICK, RI, 028883655
THE MEDICAL GROUP OF RHODE ISLAND, INC. PROFIT SHARING PLAN 2015 050383917 2016-12-01 THE MEDICAL GROUP OF RHODE ISLAND, INC. 43
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1976-10-01
Business code 621111
Sponsor’s telephone number 4014676210
Plan sponsor’s address 1050 WARWICK AVENUE, WARWICK, RI, 028883655
THE MEDICAL GROUP OF RHODE ISLAND, INC. PROFIT SHARING PLAN 2014 050383917 2015-12-01 THE MEDICAL GROUP OF RHODE ISLAND, INC. 45
File View Page
Three-digit plan number (PN) 003
Effective date of plan 1976-10-01
Business code 621111
Sponsor’s telephone number 4014676210
Plan sponsor’s address 1050 WARWICK AVENUE, WARWICK, RI, 028883655

Signature of
Role Plan administrator
Date 2015-12-01
Name of individual signing DUDLEY BENNETT
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/11/20/20141120140000P030036909023001.pdf
Three-digit plan number (PN) 003
Effective date of plan 1976-10-01
Business code 621111
Sponsor’s telephone number 4014676210
Plan sponsor’s address 1050 WARWICK AVENUE, WARWICK, RI, 028883655

Plan administrator’s name and address
Administrator’s EIN 050383917
Plan administrator’s name THE MEDICAL GROUP OF RHODE ISLAND, INC.
Plan administrator’s address 1050 WARWICK AVENUE, WARWICK, RI, 028883655
Administrator’s telephone number 4014676210

Signature of
Role Plan administrator
Date 2014-11-20
Name of individual signing DUDLEY BENNETT
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/10/25/20131025090358P040054552643001.pdf
Three-digit plan number (PN) 003
Effective date of plan 1976-10-01
Business code 621111
Sponsor’s telephone number 4014676210
Plan sponsor’s address 1050 WARWICK AVENUE, WARWICK, RI, 028883655

Plan administrator’s name and address
Administrator’s EIN 050383917
Plan administrator’s name THE MEDICAL GROUP OF RHODE ISLAND, INC.
Plan administrator’s address 1050 WARWICK AVENUE, WARWICK, RI, 028883655
Administrator’s telephone number 4014676210

Signature of
Role Plan administrator
Date 2013-10-25
Name of individual signing DUDLEY BENNETT
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/10/31/20121031154149P040003916484001.pdf
Three-digit plan number (PN) 003
Effective date of plan 1976-10-01
Business code 621111
Sponsor’s telephone number 4014676210
Plan sponsor’s address 1050 WARWICK AVENUE, WARWICK, RI, 028883655

Plan administrator’s name and address
Administrator’s EIN 050383917
Plan administrator’s name THE MEDICAL GROUP OF RHODE ISLAND, INC.
Plan administrator’s address 1050 WARWICK AVENUE, WARWICK, RI, 028883655
Administrator’s telephone number 4014676210

Signature of
Role Plan administrator
Date 2012-10-31
Name of individual signing DUDLEY BENNETT
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
MARC A. GREENFIELD Agent 116 ORANGE STREET, PROVIDENCE, RI, 02903, USA

PRESIDENT

Name Role Address
DUDLEY BENNETT PRESIDENT 56 CARDINAL LANE EAST GREENWICH, RI 02818 USA

Events

Type Date Old Value New Value
Name Change 1996-01-01 Dudley E. Bennett, D.O., Ltd. THE MEDICAL GROUP OF RHODE ISLAND, INC.

Filings

Number Name File Date
202454447990 Annual Report 2024-04-30
202334895130 Annual Report 2023-05-01
202333572410 Statement of Change of Registered/Resident Agent 2023-04-21
202330387710 Revocation Notice For Failure to Maintain a Registered Office 2023-03-10
202330034650 Registered Office Not Maintained 2023-02-08
202210051870 Annual Report 2022-02-10
202210052110 Annual Report 2022-02-10
202210051410 Reinstatement 2022-02-10
202199618710 Revocation Certificate For Failure to File the Annual Report for the Year 2021-07-29
202196716130 Revocation Notice For Failure to File An Annual Report 2021-05-19

Related by officers

MARC A. GREENFIELD

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Related by address

1030 WARWICK AVENUE, WARWICK, RI, 02888, USA

Warwick Avenue Physical Therapy, Inc.

Date of last update: 05 Oct 2024

Sources: Rhode Island Department of State

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