Richard E Donnelly, P.A.-C.

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

1105 Issued in AZ

Practice address

43 W. White Mountain Blvd
Lakeside, AZ 85929-7002

Phone

(928) 367-4040

Fax

(928) 367-4042

NPI assigned

Dec 2, 2005

Last updated

Feb 16, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Billy Creek Clinic

  • Primary Care Clinic/Center
  • Lakeside, AZ
  • NPI 1679730493
  NPD (past)

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

{
    "created_epoch": "1133481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297814400000",
    "number": "1396729455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43 W WHITE MOUNTAIN BLVD",
            "city": "LAKESIDE",
            "state": "AZ",
            "postal_code": "859297002",
            "telephone_number": "928-367-4040",
            "fax_number": "928-367-4042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43 W. WHITE MOUNTAIN BLVD",
            "city": "LAKESIDE",
            "state": "AZ",
            "postal_code": "859297002",
            "telephone_number": "928-367-4040",
            "fax_number": "928-367-4042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONNELLY",
        "first_name": "RICHARD",
        "middle_name": "E",
        "credential": "P.A.-C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-02",
        "last_updated": "2011-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AZ",
            "license": "1105",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MN",
            "license": "10186",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "970001299",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "558930400",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRIWEST",
            "identifier": "86080015085259A253",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "342254",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joan V Courtney, C. HT.
• Eric Cox
• Kent W Cox, M.D.
• Crystal Clear Hearing Centers LLC
• Dallas Peterson MD PLLC
• Ed D Lauritsen PHD PC
• Elizabeth Elgin, OTR
• Elk Ridge Surgical Specialists PLLC
• Rachel K Ellsworth, PT
• Eric Healthcare

• Surgical Physician Assistant in Lakeside, AZ
• Providers in Lakeside, AZ by specialty
• Surgical Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2011; 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.