JACOB JAMES RIDDER


Address: 12910 Pierce St Ste 120, Omaha, NE 68144-1106
Phone: (402) 933-3770

JACOB JAMES RIDDER (NPI# 1508291717) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1508291717
Entity Type Individual
Full Name JACOB JAMES RIDDER
Credential PA-C
Practice Address 12910 Pierce St Ste 120
Omaha
NE 68144-1106
Practice Telephone (402) 933-3770
Practice Fax Number 4029333633
Mailing Telephone (402) 933-3770
Mailing Fax Number 4029333633
Enumeration Date 2013-09-06
Last Update Date 2018-03-17
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 207N00000X Dermatology 1768 NE Allopathic & Osteopathic Physicians
N 363AM0700X Physician Assistant
Specialization: Medical
002439 IA Physician Assistants & Advanced Practice Nursing Providers
Y 363AM0700X Physician Assistant
Specialization: Medical
1768 NE Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
NE 10026411700 05
IA 1841673738 05

Provider Secondary Practice Location

Address Telephone Number Fax Number
928 Valley View Dr Ste 10, Council Bluffs, IA 515035288 4029333770 4029333633

Office Location

Street Address 12910 PIERCE ST STE 120
City OMAHA
State NE
Zip Code 68144-1106

Providers in the same location

NPI Name Taxonomy Address Enumeration
1316041734 James M. Shehan Dermatology 12910 Pierce St Ste 120, Omaha, NE 68144-1106 2006-09-08
1841673738 Rachel R. Person Dermatology 12910 Pierce St Ste 120, Omaha, NE 68144-1106 2015-07-09
1497182273 Advanced Dermatology of The Midlands PC Dermatology 12910 Pierce St Ste 120, Omaha, NE 68144-1106 2013-10-10
1730453200 Sara Stephenson Dermatology 12910 Pierce St Ste 120, Omaha, NE 68144-1106 2012-03-01
1851568703 Mathew Alan Davey Dermatology 12910 Pierce St Ste 120, Omaha, NE 68144-1106 2008-05-09

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1720627292 Jessica Wissink Physical Therapist 2275 South 132nd St, Omaha, NE 68144 2020-01-02
1881165397 Elle Klink Chiropractor 2527 S 140th Street, Omaha, NE 68144 2018-12-10
1336649987 Colton A Palmer Nurse Practitioner 11725 Arbor St Ste 230, Omaha, NE 68144 2018-02-20
1780121335 Deborah Palmer Massage Therapist 2429 South 120th, Omaha, NE 68144 2017-01-20
1750833851 Amanda Mcgary Tatro Counselor 11929 Elm St Suite 12a, Omaha, NE 68144 2016-10-25
1770946105 Kindis Ward Counselor 13435 A. Street, Omaha, NE 68144 2016-04-02
1649679937 Brian Douglas Smith Physical Therapist 13934 Gold Circle, Omaha, NE 68144 2014-08-22
1346587334 Elite Professionals Home Care LLC Home Health 13306 A Street, Omaha, NE 68144 2013-01-10
1821345471 Angelia D Henderson Skilled Nursing Facility 2525 S. 135th Ave, Omaha, NE 68144 2012-08-13
1073872123 Midwest Physical Therapy Services, PC Physical Therapist 11640 Arbor Street #200, Omaha, NE 68144 2012-05-10
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Taxonomy Information

Taxonomy Code 363AM0700X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant
Specialization Medical

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1669745253 Mary Maureen Garvin Physician Assistant Unmc Division of Endocrinology, 983020 Nebraska Medical Center, Omaha, NE 68198-3020 2012-02-14
1508198672 Brian Barry Nice Physician Assistant 987424 Nebraska Medical Ctr, Omaha, NE 68198-7424 2010-02-01
1407014723 Kylie Michelle Hutsell Physician Assistant 11912 Elm St Ste 26, Omaha, NE 68144-4363 2008-05-23
1093995342 Jennifer Marie Moeller Physician Assistant 984120 Nebraska Medical Ctr, Omaha, NE 68198-4120 2007-11-04
1700936978 Christina M Jensen Physician Assistant 7710 Mercy Rd Ste 502, Omaha, NE 68124-2346 2007-01-11
1104984772 Diana R Lundquist Physician Assistant 7815 Farnam Dr, Children's Home Healthcare's World, Omaha, NE 68114-4564 2006-12-05
1528153863 Mary Patricia Byam-smith Physician Assistant 1620 S 198th Ave, Omaha, NE 68130 2006-10-03
1386651172 Connie L Anderson Physician Assistant 105 N 31st Ave, Ste 102, Omaha, NE 68131-2940 2006-08-02
1194731869 Margaret Alice Antley Physician Assistant 710 S 17th St, Omaha, NE 68102-3108 2006-08-01
1033135595 Heartland Emergicare, P.C. Physician Assistant 2429 M Street, Omaha, NE 68107 2006-07-15
Find all providers in OMAHA

Competitor

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City OMAHA
Zip Code 68144

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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