Active NPI
Richard Douglas, PA-C
- Medical Physician Assistant
- Des Moines, IA
National Provider Identifier
1710935804
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 1582
- Practice address
- 3600 30TH St
Primary Care
Des Moines, IA 50310-5876 - Phone
- (515) 699-5999
- NPI assigned
- May 4, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 1582 | IA | Primary |
Addresses
Primary practice location
3600 30TH St
Primary Care
Des Moines, IA 50310-5876
Mailing address
3600 30TH St
Primary Care
Des Moines, IA 50310-5876
Phone (515) 699-5999
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110713000217 | IA | Order and Referring Only - Physician Assistant | 3375720360 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001582 | IA | MD | Mental Health Counselor |
| 1582 | IA | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1278633600000",
"number": "1710935804",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3600 30TH ST",
"address_2": "PRIMARY CARE",
"city": "DES MOINES",
"state": "IA",
"postal_code": "503105876",
"telephone_number": "515-699-5999"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3600 30TH ST",
"address_2": "PRIMARY CARE",
"city": "DES MOINES",
"state": "IA",
"postal_code": "503105876",
"telephone_number": "515-699-5999"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUGLAS",
"first_name": "RICHARD",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-04",
"last_updated": "2010-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "IA",
"license": "1582",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Des Moines, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2010; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.