Active NPI
Richard Gerard Oblak, RPA
- Radiology Practitioner Assistant
- Goodyear, AZ
National Provider Identifier
1619625696
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Radiology Practitioner Assistant
- License
- 05PA1134
- Practice address
- 13677 W McDowell Rd
Goodyear, AZ 85395-2635 - Phone
- (623) 882-1500
- NPI assigned
- Mar 17, 2022
- 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 |
|---|---|---|---|---|
| Radiology Practitioner Assistant | 243U00000X | 05PA1134 | PA | Primary |
Addresses
Primary practice location
13677 W McDowell Rd
Goodyear, AZ 85395-2635
Mailing address
4037 E White Aster St
Phoenix, AZ 85044-6796
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 05PA1134 | PA | MD | Radiology Practitioner Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1647475200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1647475200000",
"number": "1619625696",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4037 E WHITE ASTER ST",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850446796"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13677 W MCDOWELL RD",
"city": "GOODYEAR",
"state": "AZ",
"postal_code": "853952635",
"telephone_number": "623-882-1500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OBLAK",
"first_name": "RICHARD",
"middle_name": "GERARD",
"name_prefix": "Mr.",
"credential": "RPA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-03-17",
"last_updated": "2022-03-17",
"certification_date": "2022-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "243U00000X",
"taxonomy_group": "",
"desc": "Radiology Practitioner Assistant",
"state": "PA",
"license": "05PA1134",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Goodyear, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.