Mark S Rider, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

24516 Issued in TX

Practice address

558 Silicon Dr
#102
Southlake, TX 76092-7529

Phone

(817) 442-1707

Fax

(817) 424-8428

NPI assigned

Aug 2, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1244419200000",
    "number": "1336156975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "558 SILICON DR",
            "address_2": "#102",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760927529",
            "telephone_number": "817-442-1707",
            "fax_number": "817-424-8428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "558 SILICON DR",
            "address_2": "#102",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760927529",
            "telephone_number": "817-442-1707",
            "fax_number": "817-424-8428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIDER",
        "first_name": "MARK",
        "middle_name": "S",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2009-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "24516",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00K03H",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marietta Baccus Richard, PH.D
• Karisha Delvon Richards, MA, LPC
• Patricia Richardson
• Zachary L Richmond, MMFT, LPC
• Jonathan Riddel, PHD, LPC
• Penelope A Ries, DO
• Anthony M Riggio
• Jordan Rihani, MD
• Kaitlyn Michelle Rios, PT, DPT
• Mitchell Allen Riser

• Clinical Psychologist in Southlake, TX
• Providers in Southlake, TX by specialty
• Clinical Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2009; 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.

Verify at the official NPI Registry.