Individual provider Active NPI

Jeffrey Don Rediger, M.D.

  • Psychiatry Physician
  • Santa Rosa, CA
National Provider Identifier
1871525675
Registry record updated May 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
C196265 Issued in CA
Practice address
405 W College Ave
Santa Rosa, CA 95401-6506
Phone
(707) 525-5300
NPI assigned
Jul 6, 2006
Last updated
May 20, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 20, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 159462 MA
Psychiatry Physician 2084P0800X C196265 CA Primary

Addresses

Primary practice location

405 W College Ave
Santa Rosa, CA 95401-6506

Mailing address

405 W College Ave
Santa Rosa, CA 95401-6506
Phone (707) 525-5300

Other identifiers 1

IdentifierTypeStateIssuer
J25091OtherMABCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, CA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20060223000455 MA Practitioner - Psychiatry 8729094024 Reassigns benefits to 1 organization
I20250303003051 CA Practitioner - Psychiatry 8729094024 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Indiana University School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

1165 Montgomery Dr
Santa Rosa, CA 95405-4801
Phone (707) 546-3210

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
159462MAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The McLean Hospital Corporation Psychiatry CurrentSince Dec 18, 2015 Accepting new patients
Providence Medical Foundation Current Accepting new patients
Providence Medical Foundation CurrentSince Feb 1, 2025 Accepting new patients
Providence Medical Foundation CurrentSince Feb 1, 2025 Accepting new patients
St. Joseph Health Northern California, LLC PastSince May 25, 2025 Accepting new patients
Jordan Physician Associates, Inc. Past Accepting new patients
Jordan Physician Associates, Inc. Past Accepting new patients

Locations

200 W Ctr St Promenade
Ste 300
Anaheim, CA 92805
Phone (714) 449-4841

1165 Montgomery Dr
Santa Rosa, CA 95405
Phone (707) 525-5300

1165 Montgomery Dr
#1112
Santa Rosa, CA 95405
Phone (707) 546-3210

500 Doyle Park Dr
Ste 100
Santa Rosa, CA 95405
Phone (714) 449-4842

115 Mill St
Belmont, MA 02478
Phone (617) 855-2000

940 Belmont St
Brockton, MA 02301
Phone (774) 826-1106

23 Isaac St
Middleboro, MA 02346
Phone (774) 419-1000

Interoperability endpoints

  • Direct secure messaging: rediger.jeffrey.mcl@direct.partners.masshiway.net

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747699200000",
    "number": "1871525675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 W COLLEGE AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954016506",
            "telephone_number": "707-525-5300",
            "fax_number": "978-762-3922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 W COLLEGE AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954016506",
            "telephone_number": "707-525-5300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REDIGER",
        "first_name": "JEFFREY",
        "middle_name": "DON",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2025-05-20",
        "certification_date": "2025-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MA",
            "license": "159462",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "C196265",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "J25091",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

Verify at the official NPI Registry.