| Name: | Narragansett Bay Anesthesia, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Activ |
| Date of Organization in Rhode Island: | 10 Jun 2004 (21 years ago) |
| Identification Number: | 000140777 |
| ZIP code: | 02908 |
| County: | Providence County |
| Principal Address: | 42 ORIENTAL ST, PROVIDENCE, RI, 02908, USA |
| Mailing Address: | 1 UNIVERSITY AVE SUITE 104, WESTWOOD MA, MA, 02090, USA |
| Purpose: | TO ENGAGE IN THE PRACTICE OF MEDICINE SPECIALIZING IN ANESTHESIA |
| Fictitious names: |
ST. JOSEPH HOSPITAL SCHOOL OF ANESTHESIA FOR NURSES (trading name, 2021-09-14 - ) St. Joseph Hospital School of Nurse Anesthesia (trading name, 2021-09-14 - ) |
NAICS
622110 General Medical and Surgical HospitalsThis industry comprises establishments known and licensed as general medical and surgical hospitals primarily engaged in providing diagnostic and medical treatment (both surgical and nonsurgical) to inpatients with any of a wide variety of medical conditions. These establishments maintain inpatient beds and provide patients with food services that meet their nutritional requirements. These hospitals have an organized staff of physicians and other medical staff to provide patient care services. These establishments usually provide other services, such as outpatient services, anatomical pathology services, diagnostic X-ray services, clinical laboratory services, operating room services for a variety of procedures, and pharmacy services. Learn more at the U.S. Census Bureau
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1861445728 | 2006-05-19 | 2021-07-21 | 1 UNIVERSITY AVE STE 104, WESTWOOD, MA, 020902179, US | 455 TOLL GATE RD, WARWICK, RI, 028862759, US | |||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 781-915-0214 |
| Fax | 7814077712 |
Authorized person
| Name | MR. ROBERT D MCIVOR |
| Role | CEO |
| Phone | 7814077713 |
Taxonomy
| Taxonomy Code | 207L00000X - Anesthesiology Physician |
| Is Primary | Yes |
| Taxonomy Code | 208VP0014X - Interventional Pain Medicine Physician |
| Is Primary | No |
| Taxonomy Code | 367500000X - Certified Registered Nurse Anesthetist |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 9738461 |
| State | MA |
| Issuer | MEDICAID |
| Number | NB54268 |
| State | RI |
| Issuer | MEDICARE PIN |
| Number | T100650862 |
| State | NH |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NARRAGANSETT BAY ANESTHESIA, LLC 401(K) PROFIT SHARING PLAN | 2023 | 201249293 | 2024-04-30 | NARRAGANSETT BAY ANESTHESIA, LLC | 109 | |||||||||||||||||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-04-30 |
| Name of individual signing | CHAD CARROLL |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2004-08-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 4342840214 |
| Plan sponsor’s address | 42 ORIENTAL ST, PROVIDENCE, RI, 029083238 |
Signature of
| Role | Plan administrator |
| Date | 2023-07-06 |
| Name of individual signing | CHAD CARROLL |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2004-08-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 7814070995 |
| Plan sponsor’s address | 42 ORIENTAL ST, PROVIDENCE, RI, 029083238 |
Signature of
| Role | Plan administrator |
| Date | 2022-10-13 |
| Name of individual signing | KATHY SAMARAS |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2004-08-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 7814070995 |
| Plan sponsor’s address | 42 ORIENTAL ST, PROVIDENCE, RI, 029083238 |
Signature of
| Role | Plan administrator |
| Date | 2021-09-07 |
| Name of individual signing | VIJAYENDRA SUDHEENDRA |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2021-09-07 |
| Name of individual signing | VIJAYENDRA SUDHEENDRA |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2004-08-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 7819150298 |
| Plan sponsor’s address | 11 HINES FARM DRIVE, CUMBERLAND, RI, 02864 |
Plan administrator’s name and address
| Administrator’s EIN | 201249293 |
| Plan administrator’s name | PLEXUS MANAGEMENT GROUP/ NARRAGANSETT BAY ANESTHESIA |
| Plan administrator’s address | 690 CANTON STREET, SUITE 325, WESTWOOD, MA, 02090 |
| Administrator’s telephone number | 7819150298 |
Signature of
| Role | Plan administrator |
| Date | 2019-09-19 |
| Name of individual signing | KATHY SAMARAS |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2019-09-19 |
| Name of individual signing | KATHY SAMARAS |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| VIJAYENDRA SUDHEONDRA | Agent | 42 ORIENTAL STREET, PROVIDENCE, RI, 02908, USA |
| Name | Role | Address |
|---|---|---|
| VIJAYENDRA SUDHEENDRA, MD | MANAGER | 42 ORIENTAL STREET PROVIDENCE, RI 02908 USA |
| RICHARD PEDRO, MD | MANAGER | 42 ORIENTAL STREET PROVIDENCE, RI 02908 USA |
| Number | Name | File Date |
|---|---|---|
| 202449073250 | Annual Report | 2024-03-21 |
| 202333678220 | Annual Report | 2023-04-24 |
| 202213759430 | Annual Report | 2022-03-30 |
| 202103954460 | Annual Report | 2021-10-26 |
| 202101518790 | Fictitious Business Name Statement | 2021-09-14 |
| 202101517900 | Fictitious Business Name Statement | 2021-09-14 |
| 202194733850 | Annual Report | 2021-03-19 |
| 202194507550 | Revocation Notice For Failure to File An Annual Report | 2021-03-16 |
| 202042243500 | Statement of Change of Registered/Resident Agent Office | 2020-06-15 |
| 202042243320 | Annual Report - Amended | 2020-06-15 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 4853217009 | 2020-04-04 | 0165 | PPP | 11 HINES FARM DR, CUMBERLAND, RI, 02864-6174 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 09 Oct 2024
Sources: Rhode Island Department of State
