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).
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 |
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 |
State | Issuer | Identifier | Type Code |
---|---|---|---|
NE | 10026411700 | 05 | |
IA | 1841673738 | 05 |
Address | Telephone Number | Fax Number |
---|---|---|
928 Valley View Dr Ste 10, Council Bluffs, IA 515035288 | 4029333770 | 4029333633 |
Street Address |
12910 PIERCE ST STE 120 |
City | OMAHA |
State | NE |
Zip Code | 68144-1106 |
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 |
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 |
Find all providers in zip 68144 |
Taxonomy Code | 363AM0700X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Physician Assistant |
Specialization | Medical |
Definition to come... |
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 |
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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.