Individual provider Active NPI

Paul E.L. Richardson, M.D.

  • Urology Physician
  • Waterloo, IA
National Provider Identifier
1124018999
Registry record updated Jun 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
35033 Issued in IA
Practice address
3410 Kimball Ave
Waterloo, IA 50702-5735
Phone
(319) 234-2649
Fax
(319) 233-2430
NPI assigned
Oct 24, 2005
Last updated
Jun 6, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 35033 IA Primary
Urology Physician 208800000X MD489293C PA
Urology Physician 208800000X 78018 MN

Addresses

Primary practice location

3410 Kimball Ave
Waterloo, IA 50702-5735

Mailing address

3410 Kimball Ave
Waterloo, IA 50702-5735
Phone (319) 234-2649

Other practice location 1

450 S Washington St
Gettysburg, PA 17325-2500
Phone (717) 339-3105

Other practice location 2

1650 4th St SE
Rochester, MN 55904-4717
Phone (507) 529-6600

Other identifiers 5

IdentifierTypeStateIssuer
421014941-22OtherIAJOHN DEERE
34082OtherIABCBS OF IOWA
P00050800OtherIARAILROAD MEDICARE
168627OtherIACOVENTRY HMO
0289181MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA, MN, WV, PA4 enrollments
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 4

Enrollment IDStateProvider typePAC IDDetails
I20100706000274 IA Practitioner - Urology 6002996550 Reassigns benefits to 2 organizations
I20241030000607 MN Practitioner - Urology 6002996550
I20241212003858 WV Practitioner - Urology 6002996550
I20250613000403 PA Practitioner - Urology 6002996550 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Howard University College of Medicine, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellspan Medical GroupGroup PAC ID 1951213115, 2,438 clinicians

Practice addresses (Care Compare)

450 S Washington St
Gettysburg, PA 17325-2516
Phone (717) 851-6120

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35033IAMDUrology Physician
MD489293CPAMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wellspan Medical Group CurrentSince Jun 23, 2025 Accepting new patients
Spencer Municipal Hospital CurrentSince Jan 24, 2025 Accepting new patients
Spencer Municipal Hospital CurrentSince Jan 24, 2025 Accepting new patients
Spencer Municipal Hospital Current Accepting new patients
Spencer Municipal Hospital Current Accepting new patients
Reynolds Memorial Hospital, Inc CurrentSince Dec 1, 2024 Accepting new patients
Wellspan Medical Group Current Accepting new patients
Wellspan Medical Group Urology CurrentSince Dec 1, 2025 Accepting new patients
Wellspan Medical Group CurrentSince Jun 23, 2025 Accepting new patients
Floyd County Memorial Hospital Commission Past Accepting new patients
Northwest Iowa Dermatology LLC Past Accepting new patients

Locations

1200 1st Ave E
Spencer, IA 51301
Phone (712) 264-6164

1200 1st Ave E
Ste 1
Spencer, IA 51301
Phone (712) 264-6160

450 S Washington St
Gettysburg, PA 17325
Phone (717) 337-4487

1600 S George St
York, PA 17403
Phone (717) 848-3615

25 Monument Rd
Ste 270
York, PA 17403
Phone (717) 741-8250

601 Memory Ln
York, PA 17402
Phone (717) 851-6670

800 Wheeling Ave
Glen Dale, WV 26038
Phone (304) 221-4520

Interoperability endpoints

  • Direct secure messaging: prichardson476893@wellspan.direct-ci.com

Organizations & group practices 12

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 6

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": "1130112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749168000000",
    "number": "1124018999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3410 KIMBALL AVE",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507025735",
            "telephone_number": "319-234-2649",
            "fax_number": "319-233-2430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3410 KIMBALL AVE",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507025735",
            "telephone_number": "319-234-2649",
            "fax_number": "319-233-2430"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "450 S Washington St",
            "address_purpose": "LOCATION",
            "city": "Gettysburg",
            "state": "PA",
            "postal_code": "173252500",
            "country_code": "US",
            "telephone_number": "717-339-3105",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1650 4th St SE",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "MN",
            "postal_code": "559044717",
            "country_code": "US",
            "telephone_number": "507-529-6600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "PAUL",
        "middle_name": "E.L.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-24",
        "last_updated": "2025-06-06",
        "certification_date": "2025-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "IA",
            "license": "35033",
            "primary": true
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "PA",
            "license": "MD489293C",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MN",
            "license": "78018",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE",
            "identifier": "421014941-22",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF IOWA",
            "identifier": "34082",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00050800",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COVENTRY HMO",
            "identifier": "168627",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0289181",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterloo, IA

Sources for this page

Verify at the official NPI Registry.