Mal S. Riddell, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

08590 Issued in MS

Practice address

12028 Water Ridge Dr
Oxford, MS 38655-6019

Phone

(662) 809-1453

Fax

(662) 346-2851

NPI assigned

Jul 19, 2005

Last updated

Oct 7, 2026By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

83.94 of 100Reported as group

Quality

67.75

Promoting interoperability

100

Improvement activities

40

Cost

71.17

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

Practice roles

Locations

Networks

• LA PPO C-SNP

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• State of Mississippi - University of Mississippi Medical Center

  • General Acute Care Hospital
  • Jackson, MS
  • NPI 1154317527
  Medicare reassignment NPD
• Mal S Riddell, D.O. Clinic

  • Family Medicine Physician
  • Oxford, MS
  • NPI 1962634170
  Authorized official Same address or phone
• State of Mississippi-University of Mississippi Medical Center

  dba University of Mississippi Medical Center-Grenada Specialty Clinic

  • Family Medicine Physician
  • Grenada, MS
  • NPI 1932538527
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1791331200000",
    "number": "1083613210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12028 WATER RIDGE DR",
            "city": "OXFORD",
            "state": "MS",
            "postal_code": "386556019",
            "telephone_number": "662-809-1453",
            "fax_number": "662-346-2851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12028 WATER RIDGE DR",
            "city": "OXFORD",
            "state": "MS",
            "postal_code": "386556019",
            "telephone_number": "662-809-1453",
            "fax_number": "662-346-2851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIDDELL",
        "first_name": "MAL",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-19",
        "last_updated": "2026-10-07",
        "certification_date": "2026-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "08590",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00018828",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Rice Jr., BSW
• Kiffany Nicole Rice, MS
• Erik Scott Richardson, M.D.
• Randy K Richardson, MD
• Farrah Richmond, BSW
• Stacy Riddle-Mattox, MS
• Emily R Riemer, M.ED., LPC
• Jim Riffe, O.D
• Angela M Riley, MD
• Lora Davis Riley, M.ED.

• Family Medicine Physician in Oxford, MS
• Providers in Oxford, MS by specialty
• Family Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.