Jerry Rider, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2594 Issued in TN

Practice address

1650 Cochrane Cir
Fort Carson, CO 80913-4613

Phone

(719) 526-2361

NPI assigned

Dec 6, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

Practice roles

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.

• Urgent Care of Olympia

  • Urgent Care Clinic/Center
  • Olympia, WA
  • NPI 1922270891
  NPD (past)

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718236800000",
    "number": "1194884494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10TH MEDICAL GROUP/SGHC",
            "address_2": "4102 PINION DR",
            "city": "AIR FORCE ACADEMY",
            "state": "CO",
            "postal_code": "80840",
            "telephone_number": "719-684-3159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 COCHRANE CIR",
            "city": "FORT CARSON",
            "state": "CO",
            "postal_code": "809134613",
            "telephone_number": "719-526-2361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIDER",
        "first_name": "JERRY",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-06",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "2594",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TN",
            "license": "2594",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark E Reynolds, M.D.
• Matthew James Rice, DMD
• Oksana Anatolyevna Rice, DENTAL ASSISTANT
• Darcy Leigh Richardson
• Caley Richart, RDH
• Kathleen Marie Riley, R.N.
• Yahaira Rinco, DENTAL ASSISTANT
• Karina Rippy
• John Rising, R.PH.
• Elsa Nidia Rivas, DENTAL ASSISTANT

• Physician Assistant in Fort Carson, CO
• Providers in Fort Carson, CO by specialty
• Physician Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2024; 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.