Anthony Max Rousselot, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA13540 Issued in CA

Practice address

1600 Weeot Way
Arcata, CA 95521-4734

Phone

(707) 825-5010

Fax

(707) 825-6736

NPI assigned

Jul 12, 2005

Last updated

Sep 14, 2022By 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

Enrolled in CA, OR2 enrollments

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 2

Specialty

Physician Assistant

Education

University of North Dakota School of Medicine, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: anthony.rousselot.1@17520.direct.athenahealth.com

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.

• United Indian Health Services, Inc.

  • Primary Care Clinic/Center
  • Arcata, CA
  • NPI 1497751572
  Medicare reassignment NPD (past)
• P3 Medical Group PC

  • Family Medicine Physician
  • Salem, OR
  • NPI 1689266926
  Medicare reassignment
• United Indian Health Services, Inc.

  • Primary Care Clinic/Center
  • Eureka, CA
  • NPI 1588660104
  NPD

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

{
    "created_epoch": "1121126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663113600000",
    "number": "1568460608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 WEEOT WAY",
            "city": "ARCATA",
            "state": "CA",
            "postal_code": "955214734",
            "telephone_number": "707-825-5010",
            "fax_number": "707-825-6736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 WEEOT WAY",
            "city": "ARCATA",
            "state": "CA",
            "postal_code": "955214734",
            "telephone_number": "707-825-5010",
            "fax_number": "707-825-6736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROUSSELOT",
        "first_name": "ANTHONY",
        "middle_name": "MAX",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-12",
        "last_updated": "2022-09-14",
        "certification_date": "2022-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA13540",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B - PTAN",
            "identifier": "EN021Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Molly Louise Rombalski, RN
• Ronald N Barsanti DDS
• Halle Root
• Wesley Eaton Root, MD
• Alessandra Amy Elizabeth Ross, MD
• Richard Roybal
• Keaton Marie Royle Strasser
• Jerryl Lynn Rubin, M.D.
• Halona Rude, RN
• Shelley Anita Ruhlen Ponce, AMFT

• Medical Physician Assistant in Arcata, CA
• Providers in Arcata, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.