| Name: | Primary Care Medical Associates of Cranston, Inc. |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Profit Corporation |
| Status: | Activ |
| Date of Organization in Rhode Island: | 27 May 2003 (22 years ago) |
| Identification Number: | 000132275 |
| ZIP code: | 02905 |
| County: | Providence County |
| Principal Address: | 1596 BROAD STREET, CRANSTON, RI, 02905, USA |
| Purpose: | TO OPERATE A MEDICAL OFFICE AND MEDICAL LABORATORY |
NAICS
621111 Offices of Physicians (except Mental Health Specialists)This U.S. industry comprises establishments of health practitioners having the degree of M.D. (Doctor of Medicine) or D.O. (Doctor of Osteopathy) primarily engaged in the independent practice of general or specialized medicine (except psychiatry or psychoanalysis) or surgery. These practitioners operate private or group practices in their own offices (e.g., centers, clinics) or in the facilities of others, such as hospitals or HMO medical centers. Learn more at the U.S. Census Bureau
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1346307485 | 2007-01-01 | 2016-03-01 | 1596 BROAD ST, CRANSTON, RI, 029054130, US | 1596 BROAD ST, CRANSTON, RI, 029054130, US | |||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 401-461-5400 |
| Fax | 4014619039 |
Authorized person
| Name | DR. ELIZABETH G DEJESUS |
| Role | MEDICAL DIRECTOR |
| Phone | 4014615400 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | 10197 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | PC54016 |
| State | RI |
| Issuer | NEIGHBORHOOD HEALTH |
| Number | 2982 |
| State | RI |
| Issuer | TUFTS |
| Number | 469187 |
| State | RI |
| Issuer | ADVANTRA |
| Number | 759600 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| ELIZABETH G. DE JESUS | Agent | 1596 BROAD STREET, CRANSTON, RI, 02905, USA |
| Name | Role | Address |
|---|---|---|
| ELIZABETH DE JESUS | PRESIDENT | 1596 BROAD ST CRANSTON, RI 02905 USA |
| Name | Role | Address |
|---|---|---|
| BENILDE DA SILVA | SECRETARY | 2475 PAWTUCKET AVE EAST PROVIDENCE, RI 02910 USA |
| Number | Name | File Date |
|---|---|---|
| 202455180210 | Annual Report | 2024-05-31 |
| 202331222830 | Annual Report | 2023-03-21 |
| 202218055230 | Annual Report | 2022-05-31 |
| 202198175520 | Annual Report | 2021-06-11 |
| 202196817530 | Revocation Notice For Failure to File An Annual Report | 2021-05-19 |
| 202035627580 | Annual Report | 2020-03-01 |
| 201988691000 | Annual Report | 2019-03-15 |
| 201859434110 | Annual Report | 2018-02-28 |
| 201734798980 | Annual Report | 2017-02-27 |
| 201693423930 | Annual Report | 2016-02-29 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 2398217203 | 2020-04-16 | 0165 | PPP | 1596 Broad St, Cranston, RI, 02905 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 3215148303 | 2021-01-21 | 0165 | PPS | 1596 Broad St, Cranston, RI, 02905-4130 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 11 Apr 2025
Sources: Rhode Island Department of State
