Ridgewood Surgery and Endoscopy Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

RIDGEWOOD SURGERY AND ENDOSCOPY CENTER LLC

Practice address

4013 North Ridge Road
Wichita, KS 67205-8822

Phone

(913) 314-9193

NPI assigned

Jan 31, 2007

Organization subpart

No

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

Authorized official

Name

Jennifer B Baldock

Title

Officer and Authorized Official

Phone

(615) 234-5954

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in KS

Enrollment records 1

Listed as

Ridgewood Surgery and Endoscopy Center LLCCCN 17C0001076

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Cypress Surgery Center LLC

  • Ambulatory Surgical Clinic/Center
  • Wichita, KS
  • NPI 1962455964

  Member Of

  NPD member

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kelly Ann Winter, MD

  • Surgery Physician
  • Wichita, KS
  • NPI 1790214179
  Medicare reassignment NPD
• Jerry G Gaston, DO

  • Surgery Physician
  • Wichita, KS
  • NPI 1356340178
  NPD (past)

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722470400000",
    "number": "1356488837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4013 NORTH RIDGE ROAD",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672058822",
            "telephone_number": "913-314-9193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4013 NORTH RIDGE ROAD",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672058822",
            "telephone_number": "913-314-9193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIDGEWOOD SURGERY AND ENDOSCOPY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2024-08-01",
        "certification_date": "2024-08-01",
        "status": "A",
        "authorized_official_last_name": "BALDOCK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OFFICER AND AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "615-234-5954"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD KS",
            "identifier": "112228",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00428555",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200504040A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Madison Brooke Ridder
• Constance Riddle, ARNP
• Joshua L Riddle, RBT
• Rachel Rider, PA-C
• Todd Anthony Ridge, ANP
• Tara L Riedel, APRN
• Katelynn Riedesel, LMSW
• Kelsey Lynn Riefenhauser, ATC
• Kevin P Rieg, M.D.
• Rieger Medical Supply Co Inc

• Ambulatory Surgical Clinic/Center in Wichita, KS
• Providers in Wichita, KS by specialty
• Ambulatory Surgical Clinic/Center in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.