NPIMap

Individual provider Active NPI

Richard A Mouchantat, M.D.

  • Plastic and Reconstructive Surgery Physician
  • Wheat Ridge, CO
National Provider Identifier
1013937390
Registry record updated Feb 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
License
DR.0033783 Issued in CO
Practice address
3280 Wadsworth Blvd
Suite 100
Wheat Ridge, CO 80033-4628
Phone
(303) 232-8585
Fax
(303) 232-3304
NPI assigned
Jul 20, 2006
Last updated
Feb 21, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic and Reconstructive Surgery Physician 2086S0122X DR.0033783 CO Primary

Addresses

Primary practice location

3280 Wadsworth Blvd
Suite 100
Wheat Ridge, CO 80033-4628

Mailing address

3280 Wadsworth Blvd
Suite 100
Wheat Ridge, CO 80033-4628
Phone (303) 232-8585

Other identifiers 1

IdentifierTypeStateIssuer
01337831MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040803001202 CO Practitioner - Plastic and Reconstructive Surgery 3072584028 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive Surgery
Education
Tufts University School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3280 Wadsworth Blvd
Wheat Ridge, CO 80033-4640
Phone (303) 232-8585

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy13
Melanoma (skin cancer) excision1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
DR.0033783COMDPlastic and Reconstructive Surgery Physician

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676937600000",
    "number": "1013937390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3280 WADSWORTH BLVD",
            "address_2": "SUITE 100",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800334628",
            "telephone_number": "303-232-8585",
            "fax_number": "303-232-3304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3280 WADSWORTH BLVD",
            "address_2": "SUITE 100",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800334628",
            "telephone_number": "303-232-8585",
            "fax_number": "303-232-3304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOUCHANTAT",
        "first_name": "RICHARD",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-20",
        "last_updated": "2023-02-21",
        "certification_date": "2023-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "CO",
            "license": "DR.0033783",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01337831",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wheat Ridge, CO

Sources for this page

Verify at the official NPI Registry.