Active NPI
Mark Frederick Riederer, MD
- Orthopaedic Surgery Physician
- Salt Lake City, UT
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopaedic Surgery Physician
- License
- 13944824-1205
- Practice address
- 590 Wakara Way
Salt Lake City, UT 84108 - Phone
- (801) 587-7109
- NPI assigned
- Jun 2, 2006
- 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 6
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Sports Medicine Physician | 2080S0010X | 4301083195 | MI | |
| Orthopaedic Surgery Physician | 207X00000X | 4301083195 | MI | |
| Pediatric Sleep Medicine Physician | 2080S0012X | MD462484 | PA | |
| Orthopaedic Surgery Physician | 207X00000X | 13944824-1205 | UT | Primary |
| Pediatrics Physician | 208000000X | 43020 | TN | |
| Pediatrics Physician | 208000000X | 4301083195 | MI |
Addresses
Primary practice location
590 Wakara Way
Salt Lake City, UT 84108
Mailing address
590 Wakara Way
Salt Lake City, UT 84108
Phone (801) 587-7109
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | mriederer741480@direct.med.utah.edu | Direct | University of Utah |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI, UT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 43020 | TN | MD | Pediatrics Physician |
| 4301083195 | MI | MD | Pediatric Sports Medicine Physician |
| MD462484 | PA | MD | Pediatric Sleep Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University of Utah Adult Services | Current | Accepting new patients | |
| University of Utah Pediatric Services | Pediatrics | Current | Accepting new patients |
| Regents of the University of Michigan | Current | Accepting new patients | |
| University of Utah Adult Services | Current | Accepting new patients | |
| Regents of the University of Michigan | Orthopaedic Surgery | Current | Accepting new patients |
| University of Utah Adult Services | Current | Accepting new patients | |
| University of Utah Pediatric Services | Current | Accepting new patients | |
| University of Utah Pediatric Services | Current | Accepting new patients | |
| University of Utah Pediatric Services | Pediatrics | Past | Accepting new patients |
Locations
1500 E Medical Center Dr
Ann Arbor, MI 48109
Phone (734) 936-4280
3621 S State St
Ann Arbor, MI 48108
Phone (734) 647-5229
1500 E Medical Center Dr
Fl 3
Ann Arbor, MI 48109
Phone (734) 647-5944
7500 Challis Rd
Brighton, MI 48116
Phone (734) 764-4190
1051 N Canton Center Rd
Canton, MI 48187
Phone (734) 647-5670
127 S 500 E
Salt Lake Cty, UT 84102
50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292
100 N Mario Capecchi Dr
Slc, UT 84113
Phone (801) 587-7109
590 S Wakara Way
Slc, UT 84108
Phone (801) 587-7005
Interoperability endpoints
- mriederer741480@direct.med.utah.edu
- mriederer507896@direct.med.umich.edu
Organizations & group practices 9
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.
-
- General Practice Physician
- Salt Lake City, UT
- NPI 1114321981
-
- Pediatrics Physician
- Salt Lake City, UT
- NPI 1487018974
-
- Orthopaedic Surgery Physician
- Ann Arbor, MI
- NPI 1457384067
-
- Internal Medicine Physician
- Salt Lake City, UT
- NPI 1356745152
-
- Diagnostic Radiology Physician
- Salt Lake City, UT
- NPI 1598169419
-
- Pediatric Infectious Diseases Physician
- Salt Lake City, UT
- NPI 1285098855
-
- Neurological Surgery Physician
- Salt Lake City, UT
- NPI 1740644319
-
- Specialty Pharmacy
- Dexter, MI
- NPI 1952181919
-
- Pediatrics Physician
- Riverton, UT
- NPI 1043671985
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149206400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1765238400000",
"number": "1225076359",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "590 WAKARA WAY",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "84108",
"telephone_number": "801-587-7109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "590 WAKARA WAY",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "84108",
"telephone_number": "801-587-7109"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIEDERER",
"first_name": "MARK",
"middle_name": "FREDERICK",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-02",
"last_updated": "2025-12-09",
"certification_date": "2025-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "2080S0010X",
"taxonomy_group": "",
"desc": "Pediatrics, Sports Medicine",
"state": "MI",
"license": "4301083195",
"primary": false
},
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "MI",
"license": "4301083195",
"primary": false
},
{
"code": "2080S0012X",
"taxonomy_group": "",
"desc": "Pediatrics, Sleep Medicine",
"state": "PA",
"license": "MD462484",
"primary": false
},
{
"code": "207X00000X",
"taxonomy_group": "",
"desc": "Orthopaedic Surgery",
"state": "UT",
"license": "13944824-1205",
"primary": true
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TN",
"license": "43020",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MI",
"license": "4301083195",
"primary": false
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "mriederer741480@direct.med.utah.edu",
"affiliation": "Y",
"affiliationName": "University of Utah",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "50 N Medical Dr",
"city": "Salt Lake City",
"state": "UT",
"country_code": "US",
"postal_code": "841320100",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Salt Lake City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2025; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.