Nathanael W Ridge, PA, PHD

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

6833666-1206 Issued in UT

Practice address

5770 S 250 E
#290
Murray, UT 84107-8100

Phone

(801) 747-8700

Fax

(801) 747-8701

NPI assigned

Jan 13, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant, Doctor of Philosophy

State licenses

Practice roles

Locations

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.

• The Child'S Alliance, LLC

  • Medical Physician Assistant
  • Salt Lake City, UT
  • NPI 1780459016
  NPD Authorized official
• Wasatch Pediatrics, Inc

  • Pediatrics Physician
  • West Jordan, UT
  • NPI 1124102595
  NPD (past)

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

{
    "created_epoch": "1294876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700784000000",
    "number": "1134424641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5770 S 250 E",
            "address_2": "#290",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841078100",
            "telephone_number": "801-747-8700",
            "fax_number": "801-747-8701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5770 S 250 E",
            "address_2": "#290",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841078100",
            "telephone_number": "801-747-8700",
            "fax_number": "801-747-8701"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1909 S 4250 W Ofc A",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841044837",
            "country_code": "US",
            "telephone_number": "801-675-8777",
            "fax_number": "801-852-0325",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RIDGE",
        "first_name": "NATHANAEL",
        "middle_name": "W",
        "credential": "PA, PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-01-13",
        "last_updated": "2023-11-24",
        "certification_date": "2023-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "UT",
            "license": "68336662501",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "UT",
            "license": "6833666-1206",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPPES",
            "identifier": "1780459016",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alisha Richins, FNP-BC
• John Richins, RPH
• Rachael C Rickard, CSW
• Shannon Ricks, LMFT
• Heidi Marie Riddle, LCSW
• Erik Reinhard Riessen, M.D.
• Kala Riester, MS, RD, CSSD
• Eric Woodbury Rigby, MD
• Joan Riley
• Allysa Christine Rimkus, DC

• Medical Physician Assistant in Murray, UT
• Providers in Murray, UT by specialty
• Medical Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.