Active NPI
Ronald J Ridder, PHD
- Clinical Psychologist
- Cedar Rapids, IA
National Provider Identifier
1861463440
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 080046
- Practice address
- 701 10TH St SE
Cedar Rapids, IA 52403-1251 - Phone
- (319) 369-4777
- Fax
- (319) 369-4694
- NPI assigned
- Jan 31, 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PHD338 | NE | |
| Clinical Psychologist | 103TC0700X | 080046 | IA | Primary |
Addresses
Primary practice location
701 10TH St SE
Cedar Rapids, IA 52403-1251
Mailing address
701 10TH St SE
Cedar Rapids, IA 52403-1251
Phone (319) 369-4777
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NA1614001 | Other | NE | INDIVIDUAL PTAN |
| 10025567800 | Medicaid | NE | |
| 10025845100 | Medicaid | NE | |
| NA1614 | Other | NE | PTAN GROUP |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PHD338 | NE | MD | Clinical Psychologist |
| 338 | NE | MD | Athletic Trainer |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Center for Psychological Services PC | Past | Accepting new patients |
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.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Kearney, NE
- NPI 1285604637
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138665600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1450137600000",
"number": "1861463440",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "701 10TH ST SE",
"city": "CEDAR RAPIDS",
"state": "IA",
"postal_code": "524031251",
"telephone_number": "319-369-4777",
"fax_number": "319-369-4694"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 10TH ST SE",
"city": "CEDAR RAPIDS",
"state": "IA",
"postal_code": "524031251",
"telephone_number": "319-369-4777",
"fax_number": "319-369-4694"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIDDER",
"first_name": "RONALD",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-31",
"last_updated": "2015-12-15",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NE",
"license": "PHD338",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IA",
"license": "080046",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDIVIDUAL PTAN",
"identifier": "NA1614001",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10025567800",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10025845100",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PTAN GROUP",
"identifier": "NA1614",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cedar Rapids, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.