Active NPI
Richard Watson
- Durable Medical Equipment & Medical Supplies
- Grimes, IA
National Provider Identifier
1134448418
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- License
- 27-2674804
- Practice address
- 2400 SE Covenant Dr
Grimes, IA 50111-4891 - Phone
- (515) 314-9353
- NPI assigned
- May 26, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 27-2674804 | IA | Primary |
Addresses
Primary practice location
2400 SE Covenant Dr
Grimes, IA 50111-4891
Mailing address
2400 SE Covenant Dr
Grimes, IA 50111-4891
Phone (515) 314-9353
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 37311 | Medicaid | IA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27-2674804 | IA | MD | Durable Medical Equipment & Medical Supplies |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1274832000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1274832000000",
"number": "1134448418",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2400 SE COVENANT DR",
"city": "GRIMES",
"state": "IA",
"postal_code": "501114891",
"telephone_number": "515-314-9353"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2400 SE COVENANT DR",
"city": "GRIMES",
"state": "IA",
"postal_code": "501114891",
"telephone_number": "515-314-9353"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATSON",
"first_name": "RICHARD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-05-26",
"last_updated": "2010-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "IA",
"license": "27-2674804",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "37311",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grimes, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.