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  5. DRS. CONCANNON & VITALE, LLC

DRS. CONCANNON & VITALE, LLC

Company Details

Name: DRS. CONCANNON & VITALE, LLC
Jurisdiction: Rhode Island
Entity type: Domestic Limited Liability Company
Status: Activ
Date of Organization in Rhode Island: 29 Jun 2006 (19 years ago)
Identification Number: 000156960
ZIP code: 02920
County: Providence County
Principal Address: 1145 RESERVOIR AVENUE, CRANSTON, RI, 02920, USA
Mailing Address: 77 NARRAGANSETT AVENUE, JAMESTOWN, RI, 02835, USA
Purpose: PEDIATRIC AND ADOLESCENT MEDICAL PRACTICE
NAICS: 531110 - Lessors of Residential Buildings and Dwellings
Fictitious names: Atlantic-Pediatrics (trading name, 2022-01-01 - )

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1366402018 2006-03-26 2023-09-26 1145 RESERVOIR AVE, SUITE 124, CRANSTON, RI, 029206055, US 1145 RESERVOIR AVE, SUITE 124, CRANSTON, RI, 029206055, US

Contacts
Phone +1 401-943-7337
Fax 4019421509

Authorized person
Name DR. JOHN E CONCANNON
Role SENIOR PARTNER
Phone 4019437337

Taxonomy
Taxonomy Code 208000000X - Pediatrics Physician
License Number DO-357
State RI
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 601200661
State RI

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
DRS. CONCANNON & VITALE, LLC 401(K) PLAN 2023 204475410 2024-04-06 DRS. CONCANNON & VITALE, LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 4019437337
Plan sponsor’s address 1145 RESERVOIR AVENUE, SUITE 124, CRANSTON, RI, 02920

Signature of
Role Plan administrator
Date 2024-04-06
Name of individual signing COLLEEN VITALE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-04-06
Name of individual signing COLLEEN VITALE
Valid signature Filed with authorized/valid electronic signature
DRS. CONCANNON & VITALE, LLC 401(K) PLAN 2022 204475410 2023-03-28 DRS. CONCANNON & VITALE, LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 4019437337
Plan sponsor’s address 1145 RESERVOIR AVENUE, SUITE 124, CRANSTON, RI, 02920

Signature of
Role Plan administrator
Date 2023-03-28
Name of individual signing JOHN CONCANNON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-03-28
Name of individual signing JOHN CONCANNON
Valid signature Filed with authorized/valid electronic signature
DRS. CONCANNON & VITALE, LLC 401(K) PLAN 2021 204475410 2022-03-13 DRS. CONCANNON & VITALE, LLC 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 4019437337
Plan sponsor’s address 1145 RESERVOIR AVENUE, SUITE 124, CRANSTON, RI, 02920

Signature of
Role Plan administrator
Date 2022-03-13
Name of individual signing COLLEEN VITALE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-03-13
Name of individual signing COLLEEN VITALE
Valid signature Filed with authorized/valid electronic signature
DRS. CONCANNON & VITALE, LLC 401(K) PLAN 2020 204475410 2021-03-12 DRS. CONCANNON & VITALE, LLC 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 4019437337
Plan sponsor’s address 1145 RESERVOIR AVENUE, SUITE 124, CRANSTON, RI, 02920

Signature of
Role Plan administrator
Date 2021-03-12
Name of individual signing JOHN CONCANNON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-03-12
Name of individual signing JOHN CONCANNON
Valid signature Filed with authorized/valid electronic signature
DRS. CONCANNON & VITALE, LLC 401(K) PLAN 2019 204475410 2020-03-19 DRS. CONCANNON & VITALE, LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 4019437337
Plan sponsor’s address 1145 RESERVOIR AVENUE, SUITE 124, CRANSTON, RI, 02920

Signature of
Role Plan administrator
Date 2020-03-19
Name of individual signing JOHN CONCANNON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-03-19
Name of individual signing JOHN CONCANNON
Valid signature Filed with authorized/valid electronic signature
DRS. CONCANNON & VITALE, LLC 401(K) PLAN 2018 204475410 2019-06-20 DRS. CONCANNON & VITALE, LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 4019437337
Plan sponsor’s address 1145 RESERVOIR AVENUE, SUITE 124, CRANSTON, RI, 02920

Signature of
Role Plan administrator
Date 2019-06-20
Name of individual signing JOHN CONCANNON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-06-20
Name of individual signing JOHN CONCANNON
Valid signature Filed with authorized/valid electronic signature
DRS. CONCANNON & VITALE, LLC 401(K) PLAN 2017 204475410 2018-03-16 DRS. CONCANNON & VITALE, LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 4019437337
Plan sponsor’s address 1145 RESERVOIR AVENUE, SUITE 124, CRANSTON, RI, 02920

Signature of
Role Plan administrator
Date 2018-03-16
Name of individual signing JOHN CONCANNON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-03-16
Name of individual signing JOHN CONCANNON
Valid signature Filed with authorized/valid electronic signature
DRS. CONCANNON & VITALE, LLC 401(K) PLAN 2016 204475410 2017-05-09 DRS. CONCANNON & VITALE, LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 4019437337
Plan sponsor’s address 1145 RESERVOIR AVENUE, SUITE 124, CRANSTON, RI, 02920

Signature of
Role Plan administrator
Date 2017-05-09
Name of individual signing JOHN CONCANNON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-05-09
Name of individual signing JOHN CONCANNON
Valid signature Filed with authorized/valid electronic signature
DRS. CONCANNON & VITALE, LLC 401(K) PLAN 2015 204475410 2016-07-20 DRS. CONCANNON & VITALE, LLC 5
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 4019437337
Plan sponsor’s address 1145 RESERVOIR AVENUE, SUITE 124, CRANSTON, RI, 02920

Signature of
Role Plan administrator
Date 2016-07-20
Name of individual signing JOHN CONCANNON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-07-20
Name of individual signing JOHN CONCANNON
Valid signature Filed with authorized/valid electronic signature
DRS. CONCANNON & VITALE, LLC 401(K) PLAN 2014 204475410 2015-05-02 DRS. CONCANNON & VITALE, LLC 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 4019437337
Plan sponsor’s address 1145 RESERVOIR AVENUE, SUITE 124, CRANSTON, RI, 02920

Signature of
Role Plan administrator
Date 2015-05-02
Name of individual signing JOHN CONCANNON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-05-02
Name of individual signing JOHN CONCANNON
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/04/29/20140429120648P040322282291001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 4019437337
Plan sponsor’s address 1145 RESERVOIR AVENUE, SUITE 124, CRANSTON, RI, 02920

Signature of
Role Plan administrator
Date 2014-04-29
Name of individual signing JOHN CONCANNON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-04-29
Name of individual signing JOHN CONCANNON
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/05/24/20130524125136P040229490963001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 4019437337
Plan sponsor’s address 1145 RESERVOIR AVENUE, SUITE 124, CRANSTON, RI, 02920

Signature of
Role Plan administrator
Date 2013-05-24
Name of individual signing JOHN CONCANNON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2013-05-24
Name of individual signing JOHN CONCANNON
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/03/21/20120321124011P030056561121001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 4019437337
Plan sponsor’s address 1145 RESERVOIR AVENUE, SUITE 124, CRANSTON, RI, 02920

Plan administrator’s name and address
Administrator’s EIN 204475410
Plan administrator’s name DRS. CONCANNON & VITALE, LLC
Plan administrator’s address 1145 RESERVOIR AVENUE, SUITE 124, CRANSTON, RI, 02920
Administrator’s telephone number 4019437337

Signature of
Role Plan administrator
Date 2012-03-21
Name of individual signing JOHN CONCANNON, DO, FAAP
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2012-03-21
Name of individual signing JOHN CONCANNON, DO, FAAP
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/04/29/20110429160624P040051689089001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 4019437337
Plan sponsor’s address 1145 RESERVOIR AVENUE, SUITE 124, CRANSTON, RI, 02920

Plan administrator’s name and address
Administrator’s EIN 204475410
Plan administrator’s name DRS. CONCANNON & VITALE, LLC
Plan administrator’s address 1145 RESERVOIR AVENUE, SUITE 124, CRANSTON, RI, 02920
Administrator’s telephone number 4019437337

Signature of
Role Plan administrator
Date 2011-04-29
Name of individual signing JOHN CONCANNON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2011-04-29
Name of individual signing JOHN CONCANNON
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/08/19/20100819140725P040021062134001.pdf
Three-digit plan number (PN) 001
Effective date of plan 2009-01-01
Business code 621111
Sponsor’s telephone number 4019437337
Plan sponsor’s address 1145 RESERVOIR AVENUE, SUITE 124, CRANSTON, RI, 02920

Plan administrator’s name and address
Administrator’s EIN 204475410
Plan administrator’s name DRS. CONCANNON & VITALE, LLC
Plan administrator’s address 1145 RESERVOIR AVENUE, SUITE 124, CRANSTON, RI, 02920
Administrator’s telephone number 4019437337

Signature of
Role Plan administrator
Date 2010-08-19
Name of individual signing DR. JOHN CONCANNON
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2010-08-19
Name of individual signing DR. JOHN CONCANNON
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
JOHN B. MURPHY, ESQ. Agent 38 NORTH COURT STREET, PROVIDENCE, RI, 02903, USA

Filings

Number Name File Date
202453970840 Annual Report 2024-05-07
202328294220 Annual Report 2023-02-14
202213683780 Annual Report 2022-03-29
202207575750 Fictitious Business Name Statement 2022-01-01
202103828950 Annual Report 2021-10-25
202060951050 Annual Report 2020-10-04
201925000650 Annual Report 2019-10-22
201877528310 Annual Report 2018-09-17
201752425620 Annual Report 2017-10-28
201610234830 Annual Report 2016-10-12

Related by officers

JOHN B. MURPHY, ESQ.

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77 NARRAGANSETT AVENUE, JAMESTOWN, RI, 02835, USA

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Date of last update: 10 Oct 2024

Sources: Rhode Island Department of State

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