Jacob James Ridder, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

1768 Issued in NE

Practice address

12910 Pierce St Ste 120
Omaha, NE 68144-1106

Phone

(402) 933-3770

Fax

(402) 933-3633

NPI assigned

Sep 6, 2013

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IA, NE2 enrollments

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 2

Specialty

Physician Assistant

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Dermatology of the Midlands PCGroup PAC ID 5890926786, 7 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Montgomery County Memorial Hospital Hospital, Red Oak, IA, CCN 161363
• The Nebraska Medical Center Hospital, Omaha, NE, CCN 280013
• St Francis Memorial Hospital Hospital, West Point, NE, CCN 281322

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: jacob.ridder.1@9691.direct.athenahealth.com
• Direct secure messaging: jridder40378@achce.catholichealth.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Advanced Dermatology of the Midlands PC

  • Dermatology Physician
  • Omaha, NE
  • NPI 1497182273

  IA

  Medicare reassignment Care Compare group

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Franciscan Care Services Inc

  dba Franciscan Healthcare

  • Critical Access Hospital
  • West Point, NE
  • NPI 1588673578
  Care Compare affiliation
• The Nebraska Medical Center

  dba The Nebraska Medical Center - Nebraska Medicine

  • General Acute Care Hospital
  • Omaha, NE
  • NPI 1356307581
  Care Compare affiliation
• Montgomery County Memorial Hospital

  • Critical Access Hospital
  • Red Oak, IA
  • NPI 1376539338
  Care Compare affiliation

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

{
    "created_epoch": "1378425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1508291717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12910 PIERCE ST STE 120",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681441106",
            "telephone_number": "402-933-3770",
            "fax_number": "402-933-3633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12910 PIERCE ST STE 120",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681441106",
            "telephone_number": "402-933-3770",
            "fax_number": "402-933-3633"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "928 Valley View Dr Ste 10",
            "address_purpose": "LOCATION",
            "city": "Council Bluffs",
            "state": "IA",
            "postal_code": "515035288",
            "country_code": "US",
            "telephone_number": "402-933-3770",
            "fax_number": "402-933-3633",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RIDDER",
        "first_name": "JACOB",
        "middle_name": "JAMES",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-09-06",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IA",
            "license": "002439",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NE",
            "license": "1768",
            "primary": true
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NE",
            "license": "1768",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1841673738",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10026411700",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brittany Ricketts
• Kaitlyn Rickey
• Elizabeth Rico Johnson
• Jennifer Jo Riddell, APRN
• Amanda Marie Ridder, MOT, OTR/L
• Leah B Ridder, APRN
• Susan Ridder, RN-CDE
• Sam Riddle
• Julie Rideout
• Latresha D. Rideout, MA. BS. CHW. DOULA

• Medical Physician Assistant in Omaha, NE
• Providers in Omaha, NE by specialty
• Medical Physician Assistant in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.
• 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.