NPIMap

Individual provider Active NPI

John Hardisty, M.S., PA-C

  • Medical Physician Assistant
  • Decatur, AL
National Provider Identifier
1689097099
Registry record updated Jan 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
TA.1771 Issued in AL
Practice address
1201 7TH St SE
Decatur, AL 35601-3337
Phone
(256) 341-3328
Fax
(256) 341-2605
NPI assigned
Jan 22, 2014
Last updated
Jan 22, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X TA.1771 AL Primary

Addresses

Primary practice location

1201 7TH St SE
Decatur, AL 35601-3337

Mailing address

177 Ross Dr
Mountain BRK, AL 35213-2547
Phone (205) 705-9178

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, CO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180808000872 FL Practitioner - Physician Assistant 0941433411 Reassigns benefits to 1 organization
I20180920002330 CO Practitioner - Physician Assistant 0941433411 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

11600 W 2ND PL
Lakewood, CO 80228-1527
Phone (720) 321-4161

2222 N Nevada Ave
Colorado Springs, CO 80907-6794
Phone (719) 776-5333

6001 E Woodman Rd
Colorado Springs, CO 80923-2601
Phone (719) 571-1476

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Master of Science, Physician Assistant

State licenses

LicenseStateTypeSpecialty
TA.1771ALMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
FL-I Medical Services LLC CurrentSince May 15, 2018 Accepting new patients
Usacs Observation Medicine Services of Colorado Inc. CurrentSince Aug 1, 2018 Accepting new patients
FL-I Medical Services LLC CurrentSince May 15, 2018 Accepting new patients
Usacs of Colorado Inc CurrentSince Aug 1, 2018 Accepting new patients
Usacs Observation Medicine Services of Colorado, Inc CurrentSince Aug 1, 2018 Accepting new patients
Usacs of Colorado Inc CurrentSince Aug 1, 2018 Accepting new patients
Usacs Observation Medicine Services of Colorado Inc. Past Accepting new patients

Locations

2222 N Nevada Ave
Colorado Springs, CO 80907
Phone (719) 776-5333

2222 N Nevada Ave
Ste 4004
Colorado Springs, CO 80907
Phone (719) 471-7064

11600 W 2nd Pl
Lakewood, CO 80228
Phone (720) 321-1010

7700 S Broadway
Littleton, CO 80122
Phone (303) 269-4786

996 Airport Rd
Destin, FL 32541
Phone (615) 338-1250

Organizations & group practices 10

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1390348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390348800000",
    "number": "1689097099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "177 ROSS DR",
            "city": "MOUNTAIN BRK",
            "state": "AL",
            "postal_code": "352132547",
            "telephone_number": "205-705-9178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 7TH ST SE",
            "city": "DECATUR",
            "state": "AL",
            "postal_code": "356013337",
            "telephone_number": "256-341-3328",
            "fax_number": "256-341-2605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARDISTY",
        "first_name": "JOHN",
        "credential": "M.S., PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-01-22",
        "last_updated": "2014-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AL",
            "license": "TA.1771",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, AL

Sources for this page

Verify at the official NPI Registry.