Active NPI
Ken O Ridgeway, DO
- Family Medicine Physician
- Greentown, IN
National Provider Identifier
1013998723
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 2000340
- Practice address
- 712 W Main St
Greentown, IN 46936-1045 - Phone
- (765) 628-3319
- Fax
- (765) 628-5979
- NPI assigned
- Nov 9, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 2000340 | IN | Primary |
Addresses
Primary practice location
712 W Main St
Greentown, IN 46936-1045
Mailing address
712 W Main St
Greentown, IN 46936-1045
Phone (765) 628-3319
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100186930A | Medicaid | IN | |
| 000000183513 | Other | ANTHEM | |
| 10825830 | Other | CAQH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2000340 | IN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St. Joseph Primary Care, LLC | Family Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Family Medicine Physician
- Kokomo, IN
- NPI 1982736377
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131494400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193184000000",
"number": "1013998723",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "712 W MAIN ST",
"city": "GREENTOWN",
"state": "IN",
"postal_code": "469361045",
"telephone_number": "765-628-3319",
"fax_number": "765-628-5979"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "712 W MAIN ST",
"city": "GREENTOWN",
"state": "IN",
"postal_code": "469361045",
"telephone_number": "765-628-3319",
"fax_number": "765-628-5979"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIDGEWAY",
"first_name": "KEN",
"middle_name": "O",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-09",
"last_updated": "2007-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IN",
"license": "2000340",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100186930A",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000183513",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "10825830",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Greentown, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.