Jeffrey Dean Ries, D.O.

Primary specialty

SpecialistTaxonomy code 174400000X

License

20A5138 Issued in CA

Practice address

1310 San Bernardino Rd
Suite 101
Upland, CA 91786-4979

Phone

(909) 579-0779

Fax

(909) 579-0789

NPI assigned

Apr 10, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343347200000",
    "number": "1780647735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 SAN BERNARDINO RD",
            "address_2": "SUITE 101",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864985",
            "telephone_number": "909-579-0779",
            "fax_number": "909-579-0789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 SAN BERNARDINO RD",
            "address_2": "SUITE 101",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864979",
            "telephone_number": "909-579-0779",
            "fax_number": "909-579-0789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIES",
        "first_name": "JEFFREY",
        "middle_name": "DEAN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-10",
        "last_updated": "2012-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "20A5138",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00AX51380",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Upland, CA
• Providers in Upland, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.