Individual provider Active NPI

Mark Frederick Riederer, MD

  • Orthopaedic Surgery Physician
  • Salt Lake City, UT
National Provider Identifier
1225076359
Registry record updated Dec 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
13944824-1205 Issued in UT
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

Updated by the provider on Dec 9, 2025

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
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

TypeEndpointUseAffiliation
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, UT2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20041111000605 MI Practitioner - Sports MedicinePractitioner - Pediatric Medicine 3375506108 Reassigns benefits to 1 organization
I20250108003594 UT Practitioner - Orthopedic Surgery 3375506108 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
43020TNMDPediatrics Physician
4301083195MIMDPediatric Sports Medicine Physician
MD462484PAMDPediatric Sleep Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew 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 CurrentSince Jun 30, 2014 Accepting new patients
University of Utah Adult Services CurrentSince Jan 25, 2025 Accepting new patients
Regents of the University of Michigan Orthopaedic Surgery CurrentSince Jun 30, 2014 Accepting new patients
University of Utah Adult Services CurrentSince Jan 25, 2025 Accepting new patients
University of Utah Pediatric Services CurrentSince Jan 1, 2025 Accepting new patients
University of Utah Pediatric Services CurrentSince Jan 1, 2025 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

  • Direct secure messaging: mriederer741480@direct.med.utah.edu
  • Direct secure messaging: 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.

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

Verify at the official NPI Registry.