NPIMap

Individual provider Active NPI

Richard L Holmes Jr., PA-C

  • Physician Assistant
  • Lake Havasu City, AZ
National Provider Identifier
1467478396
Registry record updated Oct 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
7129 Issued in AZ
Practice address
1810 Mesquite Ave Ste B
Lake Havasu City, AZ 86403-5886
Phone
(928) 453-4600
NPI assigned
Jul 14, 2006
Last updated
Oct 14, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 7129 AZ Primary
Emergency Medicine Physician 207P00000X 7129 AZ

Addresses

Primary practice location

1810 Mesquite Ave Ste B
Lake Havasu City, AZ 86403-5886

Mailing address

11010 N Desert View LN
Flagstaff, AZ 86004-1787
Phone (928) 600-7630

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181009001661 AZ Practitioner - Physician Assistant 8921033903 Reassigns benefits to 8 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nextcare Arizona I JV LLCGroup PAC ID 7416393194, 297 clinicians

Practice addresses (Care Compare)

1000 N Humphreys St
Suite 104
Flagstaff, AZ 86001-3124
Phone (928) 779-3844

1683 E Florence Blvd
Suite 7
Casa Grande, AZ 85122-4813
Phone (520) 876-0800

1810 Mesquite Ave
Suite B
Lake Havasu City, AZ 86403-5886
Phone (928) 453-4600

399 S Malpais LN
Suite 100
Flagstaff, AZ 86001-6269
Phone (928) 286-8830

Merit-based Incentive Payment System (MIPS)

Final score
99.61 of 100Reported as group
Quality
100
Improvement activities
40
Cost
88.22

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
7129AZMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Apogee Medical Group Inc CurrentSince Feb 1, 2024 Accepting new patients
Dispatchhealth-Arizona Emergency Medicine CurrentSince May 1, 2022 Accepting new patients
Southeast Emergency Physician Associates, P.a. Emergency Medicine Past Accepting new patients
Tri-City Express Care, PLLC Past Accepting new patients
Rosebud Indian Health Service Past Accepting new patients

Locations

3269 N Stockton Hill Rd
Kingman, AZ 86409
Phone (928) 757-0626

101 Civic Center Ln
Lk Havasu Cty, AZ 86403
Phone (928) 453-0150

4602 E University Dr
Ste 150
Phoenix, AZ 85034
Phone (480) 493-3444

Interoperability endpoints

  • Direct secure messaging: richard.holmespac.p1@direct.nextcare.nextgenshare.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.

NPI Registry JSON

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728864000000",
    "number": "1467478396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11010 N DESERT VIEW LN",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860041787",
            "telephone_number": "928-600-7630",
            "fax_number": "928-600-7630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1810 MESQUITE AVE STE B",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864035886",
            "telephone_number": "928-453-4600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLMES",
        "first_name": "RICHARD",
        "middle_name": "L",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-14",
        "last_updated": "2024-10-14",
        "certification_date": "2024-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "7129",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AZ",
            "license": "7129",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Havasu City, AZ

Sources for this page

Verify at the official NPI Registry.