Active NPI
Jonathan Michael Ridenour, PSYD
- Psychologist
- Tyler, TX
National Provider Identifier
1760703003
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 34806
- Practice address
- 4801 Troup Hwy Ste 502
Tyler, TX 75703-2357 - Phone
- (903) 630-5788
- Fax
- (903) 630-5885
- NPI assigned
- Jun 22, 2010
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 34806 | TX | Primary |
Addresses
Primary practice location
4801 Troup Hwy Ste 502
Tyler, TX 75703-2357
Mailing address
4801 Troup Hwy Ste 502
Tyler, TX 75703-2357
Phone (903) 630-5788
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 34806 | Other | TEXAS LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
4801 Troup Hwy
Suite 502
Tyler, TX 75703-2357
Phone (903) 630-5788
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Psychologist
- Tyler, TX
- NPI 1699233403
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1277164800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694995200000",
"number": "1760703003",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4801 TROUP HWY STE 502",
"city": "TYLER",
"state": "TX",
"postal_code": "757032357",
"telephone_number": "903-630-5788",
"fax_number": "903-630-5885"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4801 TROUP HWY STE 502",
"city": "TYLER",
"state": "TX",
"postal_code": "757032357",
"telephone_number": "903-630-5788",
"fax_number": "903-630-5885"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIDENOUR",
"first_name": "JONATHAN",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-06-22",
"last_updated": "2023-09-18",
"certification_date": "2023-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "TX",
"license": "34806",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TEXAS LICENSE",
"identifier": "34806",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2023; 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.