Individual provider Active NPI

Richard Christman Jr., MPAS PAC

  • Physician Assistant
  • Lake Wales, FL
National Provider Identifier
1700833639
Registry record updated Apr 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2021048988 Issued in MO
Practice address
410 S 11TH St
Lake Wales, FL 33853-4203
Phone
(863) 679-6811
NPI assigned
May 27, 2006
Last updated
Apr 19, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2021048988 MO Primary
Physician Assistant 363A00000X PA-9104932 FL

Addresses

Primary practice location

410 S 11TH St
Lake Wales, FL 33853-4203

Mailing address

410 S 11TH St
Lake Wales, FL 33853-4203
Phone (863) 679-6811

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, MO2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20090327000348 FL Practitioner - Physician Assistant 4981769064 Reassigns benefits to 1 organization
I20211223001079 MO Practitioner - Physician Assistant 4981769064 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
50.12 of 100Reported as group
Quality
2.83
Improvement activities
40
Cost
82.51

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA-9104932FLMDPhysician Assistant
2021048988MOMDPhysician Assistant

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650326400000",
    "number": "1700833639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 S 11TH ST",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338534203",
            "telephone_number": "863-679-6811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 S 11TH ST",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338534203",
            "telephone_number": "863-679-6811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHRISTMAN",
        "first_name": "RICHARD",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "MPAS PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-27",
        "last_updated": "2022-04-19",
        "certification_date": "2022-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2021048988",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA-9104932",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Wales, FL

Sources for this page

Verify at the official NPI Registry.