Basic Information
| Provider Information | |||||||||
| NPI: | 1669495941 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RICHMOND | ||||||||
| FirstName: | CARI | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6626 E 75TH ST | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462502805 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1400 N. RITTER AVENUE | ||||||||
| Address2: | SUITE 370 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462193098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3173551144 | ||||||||
| FaxNumber: | 3173551155 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 10/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 146D00000X | 10000732 | IN | N | Emergency Medical Service Providers | Personal Emergency Response Attendant | 363AM0700X | 10000732A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | P01170022 | 01 | IN | RR MEDICARE PTAN | OTHER | 300005029 | 05 | IN | MEDICAID |