Individual provider Active NPI

Rickey Lee Southwell Jr., PA-C

  • Physician Assistant
  • Redding, CA
National Provider Identifier
1952811051
Registry record updated Jul 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
54920 Issued in CA
Practice address
1742 Oregon St
Redding, CA 96001-1717
Phone
(530) 646-7269
NPI assigned
Oct 4, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 54920 CA Primary

Addresses

Primary practice location

1742 Oregon St
Redding, CA 96001-1717

Mailing address

2400 Washington Ave Ste 100
Redding, CA 96001-2814
Phone (530) 530-2267

Other practice location 1

420 S Main St
Red Bluff, CA 96080-4316
Phone (530) 999-2014

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, CA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20171228000245 TX Practitioner - Physician Assistant 2769740547
I20180122001481 CA Practitioner - Physician Assistant 2769740547 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Native American Mental Health Services CorporationGroup PAC ID 5395072490, 62 clinicians

Practice addresses (Care Compare)

1742 Oregon St
Redding, CA 96001-1717
Phone (530) 646-7269

420 S Main St
Red Bluff, CA 96080-4316
Phone (888) 297-8080

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
54920CAMDPharmacotherapy Pharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Rolling Hills Clinic Past Accepting new patients

Organizations & group practices 2

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": "1507075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783468800000",
    "number": "1952811051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 WASHINGTON AVE STE 100",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960012814",
            "telephone_number": "530-530-2267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1742 OREGON ST",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960011717",
            "telephone_number": "530-646-7269"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "420 S Main St",
            "address_purpose": "LOCATION",
            "city": "Red Bluff",
            "state": "CA",
            "postal_code": "960804316",
            "country_code": "US",
            "telephone_number": "530-999-2014",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SOUTHWELL",
        "first_name": "RICKEY",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-10-04",
        "last_updated": "2026-07-08",
        "certification_date": "2026-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "54920",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redding, CA

Sources for this page

Verify at the official NPI Registry.