NPIMap

Individual provider Active NPI

Connor James Richardson, PA

  • Medical Physician Assistant
  • Prineville, OR
National Provider Identifier
1750018164
Registry record updated Apr 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA221451 Issued in OR
Practice address
384 SE Combs Flat Rd Ste 1200
Prineville, OR 97754-2562
Phone
(541) 447-6263
NPI assigned
Aug 4, 2022
Last updated
Apr 16, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 16, 2025

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
Medical Physician Assistant 363AM0700X PA221451 OR Primary

Addresses

Primary practice location

384 SE Combs Flat Rd Ste 1200
Prineville, OR 97754-2562

Mailing address

PO Box 6095
Bend, OR 97708-6095

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address crichardson207629@secure.stcharleshealthcare.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241111003700 OR Practitioner - Physician Assistant 1658805874 Reassigns benefits to 2 organizations

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
St Charles Health System IncGroup PAC ID 3870402852, shared by 10 NPIs, 174 clinicians

Practice addresses (Care Compare)

384 SE Combs Flat Rd
Prineville, OR 97754-2562
Phone (541) 706-2768

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA221451ORMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
St. Charles Health System, Inc. CurrentSince Nov 18, 2024 Accepting new patients
St. Charles Health System, Inc. CurrentSince Nov 18, 2024 Accepting new patients
St. Charles Health System, Inc. Past Accepting new patients
St. Charles Health System, Inc. Past Accepting new patients
St. Charles Health System, Inc. Past Accepting new patients

Locations

29358 Network Pl
Chicago, IL 60673

384 SE Combs Flat Rd
Ste 1200
Prineville, OR 97754
Phone (541) 447-6263

1253 NW Canal Blvd
Redmond, OR 97756
Phone (541) 548-8131

Organizations & group practices 6

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1659571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744761600000",
    "number": "1750018164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6095",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977086095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "384 SE COMBS FLAT RD STE 1200",
            "city": "PRINEVILLE",
            "state": "OR",
            "postal_code": "977542562",
            "telephone_number": "541-447-6263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "CONNOR",
        "middle_name": "JAMES",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-08-04",
        "last_updated": "2025-04-16",
        "certification_date": "2025-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OR",
            "license": "PA221451",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "crichardson207629@secure.stcharleshealthcare.org",
            "affiliation": "N",
            "address_1": "384 SE Combs Flat Rd Ste 1200",
            "city": "Prineville",
            "state": "OR",
            "country_code": "US",
            "postal_code": "977542562",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Prineville, OR

Sources for this page

Verify at the official NPI Registry.