Individual provider Active NPI

Jennifer Marie Richardson, P.A.

  • Physician Assistant
  • Kalamazoo, MI
National Provider Identifier
1700136108
Registry record updated Sep 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601006439 Issued in MI
Practice address
418 W Kalamazoo Ave
Kalamazoo, MI 49007-3334
Phone
(269) 373-6000
NPI assigned
Sep 12, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601006439 MI Primary

Addresses

Primary practice location

418 W Kalamazoo Ave
Kalamazoo, MI 49007-3334

Mailing address

2305 Oakland Dr
Kalamazoo, MI 49008-2249
Phone (269) 599-1625

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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 1

Enrollment IDStateProvider typePAC IDDetails
I20130624000029 MI Practitioner - Physician Assistant 5991944936 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Kalamazoo County Community Mental Health AuthorityGroup PAC ID 5890730337, 38 clinicians

Practice addresses (Care Compare)

610 S Burdick St
Kalamazoo, MI 49007-5221

615 E Crosstown Pkwy
Kalamazoo, MI 49001-2501
Phone (269) 373-6000

Hospital & facility affiliations

  • Bronson Methodist Hospital Hospital, Kalamazoo, MI, CCN 230017

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5601006439MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Kalamazoo County Community Mental Health Authority CurrentSince Apr 4, 2013 Accepting new patients

Locations

418 W Kalamazoo Ave
Kalamazoo, MI 49007
Phone (269) 373-6000

2030 Portage St
Kalamazoo, MI 49001
Phone (269) 553-7132

615 E Crosstown Pkwy
Kalamazoo, MI 49001
Phone (269) 373-6000

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 1

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": "1347408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347408000000",
    "number": "1700136108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2305 OAKLAND DR",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490082249",
            "telephone_number": "269-599-1625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "418 W KALAMAZOO AVE",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490073334",
            "telephone_number": "269-373-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "JENNIFER",
        "middle_name": "MARIE",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-12",
        "last_updated": "2012-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601006439",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

Verify at the official NPI Registry.