Active NPI
Jeffrey R Ridha, M.D.
- Plastic and Reconstructive Surgery Physician
- Saratoga Springs, NY
National Provider Identifier
1396927737
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic and Reconstructive Surgery Physician
- License
- 229760
- Practice address
- 72 Railroad PL
Saratoga Springs, NY 12866-3008 - Phone
- (518) 306-5466
- Fax
- (518) 306-5470
- NPI assigned
- Nov 27, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic and Reconstructive Surgery Physician | 2086S0122X | 229760 | NY | Primary |
Addresses
Primary practice location
72 Railroad PL
Saratoga Springs, NY 12866-3008
Mailing address
72 Railroad PL
Saratoga Springs, NY 12866-3008
Phone (518) 306-5466
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| J400072790 | Other | NY | MEDICARE PTAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Oct 1, 2018 through Oct 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 229760 | NY | MD | Plastic and Reconstructive Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1196121600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1449619200000",
"number": "1396927737",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "72 RAILROAD PL",
"city": "SARATOGA SPRINGS",
"state": "NY",
"postal_code": "128663008",
"telephone_number": "518-306-5466",
"fax_number": "518-306-5470"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "72 RAILROAD PL",
"city": "SARATOGA SPRINGS",
"state": "NY",
"postal_code": "128663008",
"telephone_number": "518-306-5466",
"fax_number": "518-306-5470"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIDHA",
"first_name": "JEFFREY",
"middle_name": "R",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-11-27",
"last_updated": "2015-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0122X",
"taxonomy_group": "",
"desc": "Surgery, Plastic and Reconstructive Surgery",
"state": "NY",
"license": "229760",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "J400072790",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saratoga Springs, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2015; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.