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  5. Narragansett Bay Anesthesia, LLC

Narragansett Bay Anesthesia, LLC

Company Details

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
NAICS: 622110 - General Medical and Surgical Hospitals
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 - )

National Provider Identifier

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

Contacts
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

form 5500

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
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 2024-04-30
Name of individual signing CHAD CARROLL
Valid signature Filed with authorized/valid electronic signature
NARRAGANSETT BAY ANESTHESIA, LLC 401(K) PROFIT SHARING PLAN 2022 201249293 2023-07-06 NARRAGANSETT BAY ANESTHESIA, LLC 110
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
NARRAGANSETT BAY ANESTHESIA, LLC 401(K) PROFIT SHARING PLAN 2021 201249293 2022-10-13 NARRAGANSETT BAY ANESTHESIA, LLC 99
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
NARRAGANSETT BAY ANESTHESIA, LLC 401(K) PROFIT SHARING PLAN 2020 201249293 2021-09-08 NARRAGANSETT BAY ANESTHESIA, LLC 96
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
NARRAGANSETT BAY ANESTHESIA, LLC 401(K) PROFIT SHARING PLAN 2018 201249293 2019-09-19 NARRAGANSETT BAY ANESTHESIA, LLC 103
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

Agent

Name Role Address
VIJAYENDRA SUDHEONDRA Agent 42 ORIENTAL STREET, PROVIDENCE, RI, 02908, USA

MANAGER

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

Filings

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

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 09 Oct 2024

Sources: Rhode Island Department of State

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