Individual provider Active NPI

Todd Raynor Rissacher, DC

  • Chiropractor
  • Jensen Beach, FL
National Provider Identifier
1851430409
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
7291 Issued in FL
Practice address
3215 NW Federal Hwy
Jensen Beach, FL 34957-4451
Phone
(772) 692-7899
Fax
(772) 692-7891
NPI assigned
Feb 6, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 7291 FL Primary

Addresses

Primary practice location

3215 NW Federal Hwy
Jensen Beach, FL 34957-4451

Mailing address

3215 NW Federal Hwy
Jensen Beach, FL 34957-4451
Phone (772) 692-7899

Other identifiers 2

IdentifierTypeStateIssuer
70373OtherFLBCBS
7291OtherFLCHIROPRACTIC LICENSE #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100923000957 FL Practitioner - Chiropractic 9739205014 Practice locations: Jensen Beach, FL

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3215 NW Federal Hwy
Jensen Beach, FL 34957-4451
Phone (772) 692-7899

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7291FLMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1851430409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3215 NW FEDERAL HWY",
            "city": "JENSEN BEACH",
            "state": "FL",
            "postal_code": "349574451",
            "telephone_number": "772-692-7899",
            "fax_number": "772-692-7891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3215 NW FEDERAL HWY",
            "city": "JENSEN BEACH",
            "state": "FL",
            "postal_code": "349574451",
            "telephone_number": "772-692-7899",
            "fax_number": "772-692-7891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RISSACHER",
        "first_name": "TODD",
        "middle_name": "RAYNOR",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "7291",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "70373",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHIROPRACTIC LICENSE #",
            "identifier": "7291",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jensen Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.