Individual provider Active NPI

Rola Adel Mourad, PA-C

  • Physician Assistant
  • Redding, CA
National Provider Identifier
1568025880
Registry record updated Oct 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA56840 Issued in CA
Practice address
1742 Oregon St
Redding, CA 96001-1717
Phone
(530) 646-7269
NPI assigned
Apr 22, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA56840 CA Primary

Addresses

Primary practice location

1742 Oregon St
Redding, CA 96001-1717

Mailing address

1742 Oregon St
Redding, CA 96001-1717
Phone (530) 646-7269

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201209001252 CA Practitioner - Physician Assistant 5496167835 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Native American Mental Health Services CorporationGroup PAC ID 5395072490, 62 clinicians

Practice addresses (Care Compare)

1742 Oregon St
Redding, CA 96001-1717
Phone (530) 646-7269

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
56840CAMDPharmacist
PA56840CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Northeastern Rural Health Clinics CurrentSince Apr 15, 2021 Accepting new patients
Ritter Center CurrentSince Mar 1, 2021 Accepting new patients
Karuk Tribe CurrentSince Jan 3, 2023 Accepting new patients
Karuk Tribe CurrentSince Jan 3, 2023 Accepting new patients

Locations

16 Ritter St
San Rafael, CA 94901
Phone (415) 457-8182

1850 Spring Ridge Dr
Susanville, CA 96130
Phone (530) 251-5000

1519 S Oregon St
Yreka, CA 96097
Phone (530) 842-9200

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1555891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727827200000",
    "number": "1568025880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1742 OREGON ST",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960011717",
            "telephone_number": "530-646-7269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1742 OREGON ST",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960011717",
            "telephone_number": "530-646-7269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOURAD",
        "first_name": "ROLA",
        "middle_name": "ADEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-22",
        "last_updated": "2024-10-02",
        "certification_date": "2024-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA56840",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redding, CA

Sources for this page

Verify at the official NPI Registry.