Active NPI
Raymond Rickelman, PA-C
- Physician Assistant
- Westchester, IL
National Provider Identifier
1457381345
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 085-005070
- Practice address
- 2852 Mayfair Ave
Westchester, IL 60154-5009 - Phone
- (208) 559-3757
- NPI assigned
- Jul 4, 2006
- Last updated
- Sep 30, 2015
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 085-005070 | IL | Primary |
Addresses
Primary practice location
2852 Mayfair Ave
Westchester, IL 60154-5009
Mailing address
2 E 22ND St Ste 110
Lombard, IL 60148-6100
Phone (630) 376-6317
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3175 | AZ | MD | Physical Therapist |
| 085-005070 | IL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gemini Health and Wellness LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Practice Physician
- Wheaton, IL
- NPI 1598585119
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151971200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1443571200000",
"number": "1457381345",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 E 22ND ST STE 110",
"city": "LOMBARD",
"state": "IL",
"postal_code": "601486100",
"telephone_number": "630-376-6317",
"fax_number": "630-376-6319"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2852 MAYFAIR AVE",
"city": "WESTCHESTER",
"state": "IL",
"postal_code": "601545009",
"telephone_number": "208-559-3757"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RICKELMAN",
"first_name": "RAYMOND",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-04",
"last_updated": "2015-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IL",
"license": "085-005070",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Westchester, IL
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- Katie Rhebergen
- Ivory Rhymes, NP
- Sarah L Richardson, MPT
- Rising Sun Home Health Care Inc.
- Priscilla Samantha Rivas, B.A
- Robert B Scott Ocularists LTD
- Robert B Scott Ocularists LTD (Robert B Scott Ocularists)
- Karena Rachel Robinson
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.