Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jack Richard

Individual provider Physician Assistant · NPI 1730926940

Jack Richard is a Physician Assistant in Providence, Rhode Island. Qualified in 2024, 2 years ago. Practices with University Gastroenterology, LLC, a 99-clinician group and accepts Medicare assignment. Licensed in Rhode Island.

Years since qualifying
2
Licensed in
RI
In the registry since
2024
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Practice location Address checks out

33 Staniford St
Providence, RI 02905-3105
Phone: (401) 421-8800
Fax: (401) 421-2492
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA01719 (RI)

Record details

NPI number1730926940
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJuly 15, 2024
Last updated in NPPESOctober 28, 2024
Certification dateOctober 28, 2024
Mailing address36 Whetstone St, West Newbury, MA 01985-1432

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice University Gastroenterology, Llc — 99 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Providence