Active NPI
Richard Fassola, PA-C
- Physician Assistant
- Eureka, IL
National Provider Identifier
1720331671
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 085-000933
- Practice address
- 1932 S Main St
Eureka, IL 61530-1666 - Phone
- (309) 467-5000
- Fax
- (309) 467-1500
- NPI assigned
- Oct 16, 2012
- Last updated
- Jun 15, 2016
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 085-000933 | IL | Primary |
Addresses
Primary practice location
1932 S Main St
Eureka, IL 61530-1666
Mailing address
5908 Greenview Rd
Lisle, IL 60532-2904
Phone (815) 474-2678
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085-000933 | IL | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1350345600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1465948800000",
"number": "1720331671",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5908 GREENVIEW RD",
"city": "LISLE",
"state": "IL",
"postal_code": "605322904",
"telephone_number": "815-474-2678"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1932 S MAIN ST",
"city": "EUREKA",
"state": "IL",
"postal_code": "615301666",
"telephone_number": "309-467-5000",
"fax_number": "309-467-1500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FASSOLA",
"first_name": "RICHARD",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-10-16",
"last_updated": "2016-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IL",
"license": "085-000933",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eureka, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.