Active NPI
Richard F. Rider, PSY.D.
- Psychologist
- Green Bay, WI
National Provider Identifier
1780648022
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 2677-057
- Practice address
- 301 E Saint Joseph St
Green Bay, WI 54301-2241 - Phone
- (920) 433-7992
- Fax
- (920) 431-0333
- NPI assigned
- Apr 13, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 2677-057 | WI | Primary |
| Clinical Neuropsychologist | 103G00000X | 2677-57 | WI |
Addresses
Primary practice location
301 E Saint Joseph St
Green Bay, WI 54301-2241
Mailing address
301 E Saint Joseph St
Green Bay, WI 54301-2241
Phone (920) 433-7992
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2677-57 | WI | MD | Clinical Neuropsychologist |
| 2677-057 | WI | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144886400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1395705600000",
"number": "1780648022",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 E SAINT JOSEPH ST",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543012241",
"telephone_number": "920-433-7992",
"fax_number": "920-431-0333"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 E SAINT JOSEPH ST",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543012241",
"telephone_number": "920-433-7992",
"fax_number": "920-431-0333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIDER",
"first_name": "RICHARD",
"middle_name": "F.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-13",
"last_updated": "2014-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WI",
"license": "2677-057",
"primary": true
},
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "WI",
"license": "2677-57",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.