Individual provider Active NPI

Jeannine Rider, MD

  • Psychiatry Physician
  • Brighton, MA
National Provider Identifier
1356839179
Registry record updated Nov 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
1016002 Issued in MA
Practice address
30 Warren St
Brighton, MA 02135-3602
Phone
(617) 779-1113
NPI assigned
Apr 26, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Psychiatry Physician 2084P0800X 1016002 MA Primary

Addresses

Primary practice location

30 Warren St
Brighton, MA 02135-3602

Mailing address

30 Warren St
Brighton, MA 02135-3602
Phone (617) 779-1113

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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 1

Enrollment IDStateProvider typePAC IDDetails
I20190206002786 NY Order and Referring Only - PsychiatryPractitioner - Psychiatry 4385982925

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1016002MAMDPsychiatry Physician

NPI Registry JSON

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

{
    "created_epoch": "1524700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699833600000",
    "number": "1356839179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 WARREN ST",
            "city": "BRIGHTON",
            "state": "MA",
            "postal_code": "021353602",
            "telephone_number": "617-779-1113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 WARREN ST",
            "city": "BRIGHTON",
            "state": "MA",
            "postal_code": "021353602",
            "telephone_number": "617-779-1113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIDER",
        "first_name": "JEANNINE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-26",
        "last_updated": "2023-11-13",
        "certification_date": "2023-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MA",
            "license": "1016002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brighton, MA

Sources for this page

Verify at the official NPI Registry.