Active NPI
John Raeder, DO
- Family Medicine Physician
- Reno, NV
National Provider Identifier
1760480461
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 761
- Practice address
- 18653 Wedge Pkwy
Suite 110
Reno, NV 89511-3323 - Phone
- (775) 352-7201
- NPI assigned
- Jul 7, 2005
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 761 | NV | Primary |
Addresses
Primary practice location
18653 Wedge Pkwy
Suite 110
Reno, NV 89511-3323
Mailing address
18653 Wedge Pkwy
Suite 110
Reno, NV 89511-3323
Phone (775) 352-7201
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100510794 | Medicaid | NV |
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 Osteopathy, Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1270166400000",
"number": "1760480461",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18653 WEDGE PKWY",
"address_2": "SUITE 110",
"city": "RENO",
"state": "NV",
"postal_code": "895113323",
"telephone_number": "775-352-7201"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18653 WEDGE PKWY",
"address_2": "SUITE 110",
"city": "RENO",
"state": "NV",
"postal_code": "895113323",
"telephone_number": "775-352-7201"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAEDER",
"first_name": "JOHN",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-07",
"last_updated": "2010-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "NV",
"license": "761",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100510794",
"state": "NV"
}
],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.