NPIMap

Individual provider Active NPI

Jennifer Lynn Richardson, P.A.-C

  • Medical Physician Assistant
  • Pensacola, FL
National Provider Identifier
1699767384
Registry record updated Jan 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA9101066 Issued in FL
Practice address
4511 N Davis Hwy
Suite C-1
Pensacola, FL 32503-2734
Phone
(850) 477-3252
Fax
(850) 477-2659
NPI assigned
Aug 18, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 21, 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 PA9101066 FL Primary

Addresses

Primary practice location

4511 N Davis Hwy
Suite C-1
Pensacola, FL 32503-2734

Mailing address

4511 N Davis Hwy # C-1
Pensacola, FL 32503-2720
Phone (850) 477-3252

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140210000609 FL Practitioner - Physician Assistant 7911136148 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gary Gotthelf, M.D., P.a.Group PAC ID 2466352224, 6 clinicians

Practice addresses (Care Compare)

2120 E Johnson Ave
Suite 100
Pensacola, FL 32514-6091
Phone (850) 477-3252

Hospital & facility affiliations

  • Baptist Home Health Care Home health agency, Pensacola, FL, CCN 107006
  • Mission Home Health LLC Home health agency, Pensacola, FL, CCN 687091
  • Amedisys Home Health Home health agency, Pensacola, FL, CCN 108309
  • Vitas Healthcare Corporation of Florida Hospice, Melbourne, FL, CCN 101545
  • Baptist Hospital Hospital, Pensacola, FL, CCN 100093
  • Sacred Heart Hospital Hospital, Pensacola, FL, CCN 100025
  • Gulf Breeze Hospital Hospital, Gulf Breeze, FL, CCN 100266
  • HCA Florida West Hospital Hospital, Pensacola, FL, CCN 100231

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9101066FLMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Southeastern Osteoporosis Services Inc Past Accepting new patients

Organizations & group practices 2

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.

Hospital & facility affiliations 11

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": "1124323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390262400000",
    "number": "1699767384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4511 N DAVIS HWY # C-1",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325032720",
            "telephone_number": "850-477-3252",
            "fax_number": "850-477-2659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4511 N DAVIS HWY",
            "address_2": "SUITE C-1",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325032734",
            "telephone_number": "850-477-3252",
            "fax_number": "850-477-2659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "JENNIFER",
        "middle_name": "LYNN",
        "credential": "P.A.-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-08-18",
        "last_updated": "2014-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9101066",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pensacola, FL

Sources for this page

Verify at the official NPI Registry.