Riverside Pediatrics, Inc

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

101862 Issued in MO

Legal business name

RIVERSIDE PEDIATRICS, INC

Practice address

2873 S Ingram Ave
Sedalia, MO 65301-8480

Phone

(660) 826-0027

Fax

(660) 826-1494

NPI assigned

Apr 30, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Ali Mansour Ebrahimi, MDNPI 1093930844

Title

President

Phone

(660) 826-0027

Specialties & licenses 1

Addresses

Other identifiers 5

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ali Mansour Ebrahimi, MD

  • Pediatrics Physician
  • Sedalia, MO
  • NPI 1093930844
  NPD (past) Authorized official
• Jennifer Sevier, BC PNP

  • Pediatric Nurse Practitioner
  • Sedalia, MO
  • NPI 1154697688
  NPD (past)

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

{
    "created_epoch": "1146355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1790742971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2873 S INGRAM AVE",
            "city": "SEDALIA",
            "state": "MO",
            "postal_code": "653018480",
            "telephone_number": "660-826-0027",
            "fax_number": "660-826-1494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2873 S INGRAM AVE",
            "city": "SEDALIA",
            "state": "MO",
            "postal_code": "653018480",
            "telephone_number": "660-826-0027",
            "fax_number": "660-826-1494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE PEDIATRICS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "EBRAHIMI",
        "authorized_official_first_name": "ALI",
        "authorized_official_middle_name": "MANSOUR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "660-826-0027",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MO",
            "license": "101862",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK INSURANCE",
            "identifier": "187630",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "29832018",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED INSURANCE",
            "identifier": "1200288",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHCARE USA",
            "identifier": "1922V3799",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRSTGUARD INSURANCE",
            "identifier": "101990",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Blaire Riley, LCSW
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• Roark Isl
• Linda K Roark
• Ashley R Roberts, PTA
• Terence Alan Robertson, MD

• All providers in Sedalia, MO
• Primary Care Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.

Verify at the official NPI Registry.