Individual provider Active NPI

Joseph Radich, PA-C

  • Physician Assistant
  • West Palm Beach, FL
National Provider Identifier
1932452158
Registry record updated Dec 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
9106969 Issued in FL
Practice address
2513 S Dixie Hwy
West Palm Beach, FL 33401-7917
Phone
(561) 331-2983
NPI assigned
Oct 25, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 20, 2022

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085.008904 IL
Physician Assistant 363A00000X PA59144 CA
Physician Assistant 363A00000X 001012360 NC
Medical Physician Assistant 363AM0700X 016134-1 NY
Physician Assistant 363A00000X 9106969 FL Primary

Addresses

Primary practice location

2513 S Dixie Hwy
West Palm Beach, FL 33401-7917

Mailing address

636 Fern St
West Palm Beach, FL 33401-5712
Phone (845) 863-4400

Other practice location 1

1411 N Flagler Dr Ste 9000
West Palm Beach, FL 33401-3421
Phone (561) 331-2983

Other practice location 2

11903 Southern Blvd
Suite 208
Royal Palm Beach, FL 33411-7644
Phone (561) 784-7852

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141113001572 FL Order and Referring Only - Physician Assistant 9032331756

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PA59144CAMDPhysician Assistant
9106969FLMDPhysician Assistant
085.008904ILMDPhysician Assistant
001012360NCMDPhysician Assistant
016134-1NYMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
R3 Health LLC Physician Assistant CurrentSince Apr 6, 2021 Accepting new patients
Renewu Current Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Dr. Sears Center for Health and Wellness, Inc. Past Accepting new patients

Locations

1411 N Flagler Dr
Ste 9000
West Palm Beach, FL 33401
Phone (561) 584-8460

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1351123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671494400000",
    "number": "1932452158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "636 FERN ST",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334015712",
            "telephone_number": "845-863-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2513 S DIXIE HWY",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334017917",
            "telephone_number": "561-331-2983"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1411 N Flagler Dr Ste 9000",
            "address_purpose": "LOCATION",
            "city": "West Palm Beach",
            "state": "FL",
            "postal_code": "334013421",
            "country_code": "US",
            "telephone_number": "561-331-2983",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11903 Southern Blvd",
            "address_2": "Suite 208",
            "address_purpose": "LOCATION",
            "city": "Royal Palm Beach",
            "state": "FL",
            "postal_code": "334117644",
            "country_code": "US",
            "telephone_number": "561-784-7852",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RADICH",
        "first_name": "JOSEPH",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-10-25",
        "last_updated": "2022-12-20",
        "certification_date": "2022-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.008904",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA59144",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "001012360",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "016134-1",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "9106969",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Palm Beach, FL

Sources for this page

Verify at the official NPI Registry.