Active NPI
Jeffrey Van Richards, PA-C
- Physician Assistant
- Green Bay, WI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 4288-23
- Practice address
- 2502 S Ashland Ave
Green Bay, WI 54304-5252 - Phone
- (920) 496-4700
- NPI assigned
- Sep 26, 2012
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1815 | MN | |
| Physician Assistant | 363A00000X | 4288-23 | WI | Primary |
Addresses
Primary practice location
2502 S Ashland Ave
Green Bay, WI 54304-5252
Mailing address
PO Box 19070
Green Bay, WI 54307-9070
Phone (920) 496-4700
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1601 Lawrence Dr
Suite 100
De Pere, WI 54115-3931
Phone (920) 496-4700
1860 Shawano Ave
Green Bay, WI 54303-2667
Phone (920) 496-4700
2502 S Ashland Ave
Green Bay, WI 54304-5252
Phone (920) 496-4700
2793 Lineville Rd
Green Bay, WI 54313-7152
Phone (920) 496-4700
3021 Voyager Dr
Green Bay, WI 54311-8303
Phone (920) 496-4700
3750 Investors CT
Grand Chute, WI 54913-2330
Phone (920) 496-4700
3860 Monroe Rd
De Pere, WI 54115-8399
Phone (920) 496-4700
835 S Van Buren St
Green Bay, WI 54301-3526
Phone (920) 496-4700
Hospital & facility affiliations
- St Vincent Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 94.81 of 100
- Quality
- 85.98
- Promoting interoperability
- 100
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4288-23 | WI | MD | Physician Assistant |
| 11257 | MN | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Vincent Hospital-Hospital Sisters-Third Order of St Francis | Current | Accepting new patients | |
| St Vincent Hospital-Hospital Sisters-Third Order of St Francis | Current | Accepting new patients | |
| Prevea Clinic, Inc. | Current | Accepting new patients | |
| St Nicholas Hospital-Sisters of the Third Order of St Francis | Current | Accepting new patients |
Locations
1726 Shawano Ave
Green Bay, WI 54303
Phone (920) 432-6016
835 S Van Buren St
Green Bay, WI 54301
Phone (888) 901-7246
2502 S Ashland Ave
Green Bay, WI 54304
Phone (920) 496-4750
3100 Superior Ave
Sheboygan, WI 53081
Phone (800) 472-6710
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 and National Provider Directory roles.
-
- General Practice Physician
- Green Bay, WI
- NPI 1285613638
-
- Internal Medicine Physician
- Green Bay, WI
- NPI 1306869276
-
- Internal Medicine Physician
- Sheboygan, WI
- NPI 1275799413
-
- Internal Medicine Physician
- Sheboygan, WI
- NPI 1447737762
-
- Otolaryngology Physician
- Shawano, WI
- NPI 1194314013
-
- Durable Medical Equipment & Medical Supplies
- Green Bay, WI
- NPI 1245042530
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Green Bay, WI
- NPI 1114908001
-
- Hematology & Oncology Physician
- Sheboygan, WI
- NPI 1831784636
Hospital
-
- Hematology & Oncology Physician
- Green Bay, WI
- NPI 1184004236
Hospital
-
- Hematology & Oncology Physician
- Oconto Falls, WI
- NPI 1750760740
Hospital
-
- Hematology & Oncology Physician
- Sturgeon Bay, WI
- NPI 1760861751
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348617600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675900800000",
"number": "1760733133",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 19070",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543079070",
"telephone_number": "920-496-4700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2502 S ASHLAND AVE",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543045252",
"telephone_number": "920-496-4700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RICHARDS",
"first_name": "JEFFREY",
"middle_name": "VAN",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-09-26",
"last_updated": "2023-02-09",
"certification_date": "2023-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MN",
"license": "1815",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WI",
"license": "4288-23",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2023; 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.