Active NPI
Jack Richard
- Physician Assistant
- Providence, RI
National Provider Identifier
1730926940
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA01719
- Practice address
- 33 Staniford St
Providence, RI 02905-3105 - Phone
- (401) 421-8800
- Fax
- (401) 421-2492
- NPI assigned
- Jul 15, 2024
- 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 | PA01719 | RI | Primary |
Addresses
Primary practice location
33 Staniford St
Providence, RI 02905-3105
Mailing address
36 Whetstone St
West Newbury, MA 01985-1432
Phone (978) 914-4086
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in RI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
33 Staniford St
Providence, RI 02905-3105
Phone (401) 421-8800
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA01719 | RI | MD | Physician Assistant |
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.
-
- Gastroenterology Physician
- Providence, RI
- NPI 1386952612
-
- Gastroenterology Physician
- Providence, RI
- NPI 1093723546
Hospital & facility affiliations 7
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Rehabilitation Hospital Unit
- Warwick, RI
- NPI 1023017944
-
- General Acute Care Hospital
- Warwick, RI
- NPI 1386643294
-
- General Acute Care Hospital
- Providence, RI
- NPI 1588659528
-
- General Acute Care Hospital
- Providence, RI
- NPI 1972768174
-
- General Acute Care Hospital
- Providence, RI
- NPI 1487649430
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721001600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730073600000",
"number": "1730926940",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "36 WHETSTONE ST",
"city": "WEST NEWBURY",
"state": "MA",
"postal_code": "019851432",
"telephone_number": "978-914-4086"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "33 STANIFORD ST",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029053105",
"telephone_number": "401-421-8800",
"fax_number": "401-421-2492"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RICHARD",
"first_name": "JACK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-07-15",
"last_updated": "2024-10-28",
"certification_date": "2024-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "RI",
"license": "PA01719",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Providence, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2024; 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.