Az Richardson Surgical Services, LLC

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

2908 Issued in AZ

Legal business name

AZ RICHARDSON SURGICAL SERVICES, LLC

Practice address

1776 N Scottsdale Rd Unit 368
Scottsdale, AZ 85252-3616

Phone

(480) 201-5264

Fax

(480) 393-1970

NPI assigned

Oct 22, 2012

Last updated

Mar 7, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Keri L Richardson, PA-CNPI 1447244355

Title

Member

Phone

(480) 586-0554

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Keri Lynn Richardson, PA-C

  • Physician Assistant
  • Phoenix, AZ
  • NPI 1447244355
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1350864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709769600000",
    "number": "1679826051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 368",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852520368",
            "telephone_number": "480-201-5264",
            "fax_number": "480-393-1970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1776 N SCOTTSDALE RD UNIT 368",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852523616",
            "telephone_number": "480-201-5264",
            "fax_number": "480-393-1970"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6417 E Star Valley St",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852150891",
            "country_code": "US",
            "telephone_number": "480-586-0554",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "AZ RICHARDSON SURGICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-22",
        "last_updated": "2024-03-07",
        "certification_date": "2024-03-07",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "KERI",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "480-586-0554",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AZ",
            "license": "2908",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Surgical Physician Assistant in Scottsdale, AZ
• Providers in Scottsdale, AZ by specialty
• Surgical Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.