Russell E Rider, MD
Individual provider Active NPI Family Medicine Physician · Long Lake, NY
NPI 1245244649 · NPPES record last updated Sep 11, 2014
Key facts
- NPI
- 1245244649
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 1712651 (NY)
- Practice address
- 8561 Newcomb Rd
Long Lake, NY 12847-0129 - Phone
- (518) 624-2301
- Fax
- (518) 624-2043
- NPI assigned
- Jul 28, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- State University of Ny Upstate Medical University, 1986
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
4 Santanoni Dr
Newcomb, NY 12852-1913
Phone (518) 582-2991
8561 Newcomb Rd
Long Lake, NY 12847-7785
Phone 518624230111
PO Box
Suite 129
Long Lake, NY 12847-0129
Hospital & facility affiliations
- High Peaks Hospice and Palliative Care, Inc
- Adirondack Medical Center - Saranac Lake
- Glens Falls Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 88.88 of 100
- Quality
- 71.44
- Promoting interoperability
- 97.95
- Improvement activities
- 40
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of tissue | 1-10 |
| Removal of skin lesions | 1-10 |
| Removal or shaving of skin growth | 15 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050825000599 | NY | Practitioner - Family Practice | 3476583857 |
Receives reassigned benefits from 2 practitioners Practice locations: Long Lake, NY; Newcomb, NY |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1712651 | NY | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Russell E Rider, MD | Family Medicine | Past | Accepting new patients |
Interoperability endpoints
- russell.rider.4@2469.direct.athenahealth.com
- https://api.platform.athenahealth.com/2469/brand/4/csg/23/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 1712651 | NY | Yes |
Addresses
Primary practice location
8561 Newcomb Rd
Long Lake, NY 12847-0129
Mailing address
PO Box 129
Long Lake, NY 12847-0129
Phone (518) 624-2301
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01110874 | Medicaid | NY |
Other providers in Long Lake, NY
- Long Lake Central School
- Long Lake Rescue Squad Inc
- Vickie L Plumley
- Michael J Small
- Evangeline Helen Wells
All providers in Long Lake, NY · Family Medicine Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 11, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.