Brian D Ridgely, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA3524 Issued in FL

Practice address

1651 SE Tiffany Ave
Port St Lucie, FL 34952-7564

Phone

(772) 398-1800

Fax

(772) 398-1815

NPI assigned

Jul 27, 2006

Last updated

Jun 15, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1276560000000",
    "number": "1326062977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 417",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349950417",
            "telephone_number": "772-223-5665",
            "fax_number": "772-223-5646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1651 SE TIFFANY AVE",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349527564",
            "telephone_number": "772-398-1800",
            "fax_number": "772-398-1815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIDGELY",
        "first_name": "BRIAN",
        "middle_name": "D",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2010-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA3524",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "290394600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cathy Riccio, L.AC.
• Rich Ready Wheels
• Jennifer Smith Richards, PSYD
• Shirmel T. Richards, DNP, APRN
• Denise Ricketts Grant, M.D.
• Alejandra Michelle Riera de Jesus, DMD
• Christine Rigg, HOMEMAKER COMPANION
• Andrew Rigney, PT, DPT
• Janet E Riley, AUD
• Sylvie Anne Rimmer, M.D.

• Physician Assistant in Port St Lucie, FL
• Providers in Port St Lucie, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 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.

Verify at the official NPI Registry.