Individual provider Active NPI

Richard A. Timmerman Jr., P.A.

  • Physician Assistant
  • Mission Viejo, CA
National Provider Identifier
1083809552
Registry record updated Sep 7, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA19082 Issued in CA
Practice address
27700 Medical Center Rd
Mission Viejo, CA 92691-6426
Phone
(949) 364-1400
Fax
(949) 365-4941
NPI assigned
Sep 7, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA19082 CA Primary

Addresses

Primary practice location

27700 Medical Center Rd
Mission Viejo, CA 92691-6426

Mailing address

PO Box 660099
Arcadia, CA 91066-0099
Phone (626) 447-0296

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071109000350 CA Practitioner - Physician Assistant 3870681760 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA19082CAMDPhysician Assistant

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1189123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1189123200000",
    "number": "1083809552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 660099",
            "city": "ARCADIA",
            "state": "CA",
            "postal_code": "910660099",
            "telephone_number": "626-447-0296",
            "fax_number": "626-447-6057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27700 MEDICAL CENTER RD",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926916426",
            "telephone_number": "949-364-1400",
            "fax_number": "949-365-4941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIMMERMAN",
        "first_name": "RICHARD",
        "middle_name": "A.",
        "name_suffix": "Jr.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-07",
        "last_updated": "2007-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA19082",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mission Viejo, CA

Sources for this page

Verify at the official NPI Registry.