Willie Forrest Richardson Jr., MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

ME94167 Issued in FL

Practice address

1120 Bayview Dr
Fort Lauderdale, FL 33304-2505

Phone

(954) 537-4106

Fax

(954) 537-4186

NPI assigned

Aug 28, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

Brody School of Medicine at East Carolina University, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Will Richardson MD PAGroup PAC ID 4688676836, 3 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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

• Will Richardson MD PA

  • Medical Specialty Clinic/Center
  • Fort Lauderdale, FL
  • NPI 1508952458
  Medicare reassignment Care Compare group NPD Authorized official
• Will Richardson MD PA

  • Dermatology Physician
  • Coconut Creek, FL
  • NPI 1225315385
  NPD Authorized official
• Pro Performance Physical Therapy LLC

  • Physical Therapist
  • Fort Lauderdale, FL
  • NPI 1215598529
  NPD (past)
• DHHS, PHS, Naihs, Gallup Indian Medical Center

  • Ambulatory Surgical Clinic/Center
  • Gallup, NM
  • NPI 1184890899
  NPD (past)

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

{
    "created_epoch": "1156723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320278400000",
    "number": "1043328230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 BAYVIEW DR",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333042505",
            "telephone_number": "954-537-4106",
            "fax_number": "954-537-4186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 BAYVIEW DR",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333042505",
            "telephone_number": "954-537-4106",
            "fax_number": "954-537-4186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "WILLIE",
        "middle_name": "FORREST",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-28",
        "last_updated": "2011-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "FL",
            "license": "ME94167",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Schedavia Lateisha Richards
• Yvonne Elizabeth Richards
• Laverne Richardson Emmanuel, ARNP
• Fritz Richardson Jr., CEO, OWNER
• Taylor L Richardson, APRN
• Danielle Erin Richmond, PA
• Kristi Watson Ricks, OTR/L
• Jennifer Ridenoure, P.A.C
• Ridestat LLC
• Toni Rieger, M.S

• Dermatology Physician in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.