Hasan Raza, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

346123 Issued in WI

Practice address

17 S River St
Suite 254
Janesville, WI 53548-3860

Phone

(608) 755-5260

NPI assigned

Nov 4, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

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

Specialty

Physician Assistant

Education

Other, 2013

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Trivium LLCGroup PAC ID 6800115676, 12 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Trivium LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Janesville, WI
  • NPI 1265450753
  Medicare reassignment Care Compare group
• Trivium LLC

  • Adolescent and Children Mental Health Clinic/Center
  • Sun Prairie, WI
  • NPI 1427463066
  NPD (past)

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

{
    "created_epoch": "1415059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445904000000",
    "number": "1710382601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 S RIVER ST",
            "address_2": "SUITE 254",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535483860",
            "telephone_number": "608-755-5260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 S RIVER ST",
            "address_2": "SUITE 254",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535483860",
            "telephone_number": "608-755-5260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAZA",
        "first_name": "HASAN",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-11-04",
        "last_updated": "2015-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WI",
            "license": "346123",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WI",
            "license": "346123",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1710382601",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Megan Rapp, DC
• Mehreen S Rathore, MD
• Karri L Ratzlaff, RN, MS
• Teresa L Rauscher, PT
• Ashley Sue Ray
• Jill Reasa, APSW
• Dawn M. Recker, PHARM.D.
• Red Road House
• Anne Marie Reed, MD
• Betsy L Reed, LCSW

• Medical Physician Assistant in Janesville, WI
• Providers in Janesville, WI by specialty
• Medical Physician Assistant in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.