NPIMap

Individual provider Active NPI

Ronald Kip Rider, P.A.-C

  • Physician Assistant
  • Hollywood, FL
National Provider Identifier
1578504866
Registry record updated Apr 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA 9100646 Issued in FL
Practice address
3702 Washington St
Suite 305
Hollywood, FL 33021-8282
Phone
(954) 967-6550
Fax
(954) 967-6553
NPI assigned
Jun 9, 2006
Last updated
Apr 13, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA 9100646 FL Primary

Addresses

Primary practice location

3702 Washington St
Suite 305
Hollywood, FL 33021-8282

Mailing address

3702 Washington St
Suite 403
Hollywood, FL 33021-8282
Phone (954) 967-6550

Other identifiers 1

IdentifierTypeStateIssuer
290649000MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150513000922 FL Practitioner - Physician Assistant 9931425261 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of MiamiGroup PAC ID 3274795109, 2,346 clinicians

Practice addresses (Care Compare)

4800 NE 20TH Ter
Fort Lauderdale, FL 33308-4510

4800 NE 20TH Terrace
201 Uhealth Cardiology at Ft Lauderdale
Fort Lauderdale, FL 33308-4510
Phone (305) 243-3440

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.93 of 100Reported as group
Quality
78.79
Promoting interoperability
100
Improvement activities
40
Cost
71.44

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA 9100646FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of Miami CurrentSince Jan 1, 2020 Accepting new patients
University of Miami CurrentSince Jan 1, 2020 Accepting new patients
North Ridge Emergency Physicians, PA Past Accepting new patients
Healthstone Medical Group, LLC Past Accepting new patients
University of Miami Past Accepting new patients

Locations

4800 NE 20th Ter
Ste 201
Ft Lauderdale, FL 33308
Phone (305) 892-4000

1295 NW 14th St
Ste A
Miami, FL 33125
Phone (305) 243-0783

1611 NW 12th Ave
Miami, FL 33136
Phone (305) 585-6226

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: rrider46919@direct.med.miami.edu

Organizations & group practices 6

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428883200000",
    "number": "1578504866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3702 WASHINGTON ST",
            "address_2": "SUITE 403",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330218282",
            "telephone_number": "954-967-6550",
            "fax_number": "954-967-6553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3702 WASHINGTON ST",
            "address_2": "SUITE 305",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330218282",
            "telephone_number": "954-967-6550",
            "fax_number": "954-967-6553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIDER",
        "first_name": "RONALD",
        "middle_name": "KIP",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2015-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA 9100646",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "290649000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hollywood, FL

Sources for this page

Verify at the official NPI Registry.