Jeremy Mark Ridenour, PSY.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

10216 Issued in MA

Practice address

25 Main Street
Stockbridge, MA 01262-0962

Phone

(903) 258-5876

Fax

(413) 298-4020

NPI assigned

Feb 15, 2016

Last updated

Apr 21, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 17, 2017 through Jul 17, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1455494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555804800000",
    "number": "1831558238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 MAIN STREET",
            "address_2": "PO BOX 962",
            "city": "STOCKBRIDGE",
            "state": "MA",
            "postal_code": "012620962",
            "telephone_number": "413-931-5283",
            "fax_number": "413-298-4020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 MAIN STREET",
            "city": "STOCKBRIDGE",
            "state": "MA",
            "postal_code": "012620962",
            "telephone_number": "903-258-5876",
            "fax_number": "413-298-4020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIDENOUR",
        "first_name": "JEREMY",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-02-15",
        "last_updated": "2019-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "VT",
            "license": "048.0117056",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MA",
            "license": "10216",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eric Martin Plakun, MD
• Marion Pomeroy
• Cheryl A Puntil, MN, APRN, PMHCNS,BC
• R.L.Williams PSYD, PLLC
• Robin Joy Renders, PH.D.
• Madeline Lee River, PSY.D
• John Thomas Rucker III, PSY.D.
• James L Sacksteder, M.D.
• Hannah Schmitt
• Avram Schwartz, MSW

• Psychologist in Stockbridge, MA
• Providers in Stockbridge, MA by specialty
• Psychologist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2019; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.