Active NPI
Richard Dicarlo
- Physician Assistant
- Henderson, NV
National Provider Identifier
1831167691
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA997
- Practice address
- 2662 W Horizon Ridge Pkwy
Henderson, NV 89052-2844 - Phone
- (702) 616-9660
- Fax
- (702) 616-9671
- NPI assigned
- Mar 9, 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601003821 | MI | |
| Medical Physician Assistant | 363AM0700X | PA997 | NV | |
| Physician Assistant | 363A00000X | PA997 | NV | Primary |
Addresses
Primary practice location
2662 W Horizon Ridge Pkwy
Henderson, NV 89052-2844
Mailing address
2011 E Lake Mead Blvd
North Las Vegas, NV 89030-7135
Phone (702) 286-6830
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00376993 | Other | NV | RAILROAD MEDICARE |
| 100509907 | Medicaid | NV |
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
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601003821 | MI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nevada CVS Pharmacy LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Pharmacy
- Las Vegas, NV
- NPI 1528581865
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141862400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1386547200000",
"number": "1831167691",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2011 E LAKE MEAD BLVD",
"city": "NORTH LAS VEGAS",
"state": "NV",
"postal_code": "890307135",
"telephone_number": "702-286-6830"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2662 W HORIZON RIDGE PKWY",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890522844",
"telephone_number": "702-616-9660",
"fax_number": "702-616-9671"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICARLO",
"first_name": "RICHARD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-09",
"last_updated": "2013-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MI",
"license": "5601003821",
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "NV",
"license": "PA997",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NV",
"license": "PA997",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00376993",
"state": "NV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100509907",
"state": "NV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Henderson, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.