Individual provider Active NPI

Eric David Rideman, D.O.

  • Surgery Physician
  • Lake Mary, FL
National Provider Identifier
1396057394
Registry record updated Jun 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
OS13629 Issued in FL
Practice address
4106 W Lake Mary Blvd Ste 330
Lake Mary, FL 32746-3383
Phone
(407) 833-9195
Fax
(407) 833-9308
NPI assigned
Jul 7, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X OS13629 FL Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

4106 W Lake Mary Blvd Ste 330
Lake Mary, FL 32746-3383

Mailing address

4106 W Lake Mary Blvd Ste 330
Lake Mary, FL 32746-3383
Phone (407) 833-9195

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20160718001540 FL Practitioner - General Surgery 0749592442 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Hospital Medical Group Inc CurrentSince Jul 25, 2016 Accepting new patients
Florida Hospital Medical Group Inc Surgery CurrentSince Jul 25, 2016 Accepting new patients

Locations

4106 W Lake Mary Blvd
Ste 330
Lake Mary, FL 32746
Phone (386) 775-2012

2600 Westhall Ln
Ste 4
Maitland, FL 32751
Phone (407) 200-2700

Organizations & group practices 2

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": "1278460800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466640000000",
    "number": "1396057394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4106 W LAKE MARY BLVD STE 330",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327463383",
            "telephone_number": "407-833-9195",
            "fax_number": "407-833-9308"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4106 W LAKE MARY BLVD STE 330",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327463383",
            "telephone_number": "407-833-9195",
            "fax_number": "407-833-9308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIDEMAN",
        "first_name": "ERIC",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-07",
        "last_updated": "2016-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "OS13629",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Mary, FL

Sources for this page

Verify at the official NPI Registry.