Active NPI
Robert V Ridenour Jr., MD
- Anatomic Pathology & Clinical Pathology Physician
- Eau Claire, WI
National Provider Identifier
1700834355
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 28061020
- Practice address
- 900 West Clairemont Ave
Eau Claire, WI 54701 - Phone
- (715) 839-4121
- NPI assigned
- May 5, 2006
- 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 12
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Blood Banking & Transfusion Medicine Physician | 207ZB0001X | 28061020 | WI | |
| Cytopathology Physician | 207ZC0500X | 28061020 | WI | |
| Dermatopathology (Pathology) Physician | 207ZD0900X | 28061020 | WI | |
| Forensic Pathology Physician | 207ZF0201X | 28061020 | WI | |
| Hematology (Pathology) Physician | 207ZH0000X | 28061020 | WI | |
| Immunopathology Physician | 207ZI0100X | 28061020 | WI | |
| Medical Microbiology Physician | 207ZM0300X | 28061020 | WI | |
| Neuropathology Physician | 207ZN0500X | 28061020 | WI | |
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 28061020 | WI | Primary |
| Chemical Pathology Physician | 207ZP0104X | 28061020 | WI | |
| Clinical Pathology/Laboratory Medicine Physician | 207ZP0105X | 28061020 | WI | |
| Pediatric Pathology Physician | 207ZP0213X | 28061020 | WI |
Addresses
Primary practice location
900 West Clairemont Ave
Eau Claire, WI 54701
Mailing address
2715 West Frank Street
Eau Claire, WI 54703
Phone (715) 832-6445
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30789100 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28061020 | WI | MD | Dermatopathology (Pathology) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146787200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421798400000",
"number": "1700834355",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2715 WEST FRANK STREET",
"city": "EAU CLAIRE",
"state": "WI",
"postal_code": "54703",
"telephone_number": "715-832-6445",
"fax_number": "715-834-5870"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "900 WEST CLAIREMONT AVE",
"city": "EAU CLAIRE",
"state": "WI",
"postal_code": "54701",
"telephone_number": "715-839-4121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIDENOUR",
"first_name": "ROBERT",
"middle_name": "V",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-05",
"last_updated": "2015-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "207ZB0001X",
"taxonomy_group": "",
"desc": "Pathology, Blood Banking & Transfusion Medicine",
"state": "WI",
"license": "28061020",
"primary": false
},
{
"code": "207ZC0500X",
"taxonomy_group": "",
"desc": "Pathology, Cytopathology",
"state": "WI",
"license": "28061020",
"primary": false
},
{
"code": "207ZD0900X",
"taxonomy_group": "",
"desc": "Pathology, Dermatopathology",
"state": "WI",
"license": "28061020",
"primary": false
},
{
"code": "207ZF0201X",
"taxonomy_group": "",
"desc": "Pathology, Forensic Pathology",
"state": "WI",
"license": "28061020",
"primary": false
},
{
"code": "207ZH0000X",
"taxonomy_group": "",
"desc": "Pathology, Hematology",
"state": "WI",
"license": "28061020",
"primary": false
},
{
"code": "207ZI0100X",
"taxonomy_group": "",
"desc": "Pathology, Immunopathology",
"state": "WI",
"license": "28061020",
"primary": false
},
{
"code": "207ZM0300X",
"taxonomy_group": "",
"desc": "Pathology, Medical Microbiology",
"state": "WI",
"license": "28061020",
"primary": false
},
{
"code": "207ZN0500X",
"taxonomy_group": "",
"desc": "Pathology, Neuropathology",
"state": "WI",
"license": "28061020",
"primary": false
},
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "WI",
"license": "28061020",
"primary": true
},
{
"code": "207ZP0104X",
"taxonomy_group": "",
"desc": "Pathology, Chemical Pathology",
"state": "WI",
"license": "28061020",
"primary": false
},
{
"code": "207ZP0105X",
"taxonomy_group": "",
"desc": "Pathology, Clinical Pathology/Laboratory Medicine",
"state": "WI",
"license": "28061020",
"primary": false
},
{
"code": "207ZP0213X",
"taxonomy_group": "",
"desc": "Pathology, Pediatric Pathology",
"state": "WI",
"license": "28061020",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30789100",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Eau Claire, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.