Individual provider Active NPI

James S Riedel, ED.D.

  • Clinical Psychologist
  • Woodridge, IL
National Provider Identifier
1871639203
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Practice address
7425 Janes Ave
Suite 200
Woodridge, IL 60517-2356
Phone
(630) 852-8451
Fax
(630) 852-0554
NPI assigned
Jan 30, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X IL Primary

Addresses

Primary practice location

7425 Janes Ave
Suite 200
Woodridge, IL 60517-2356

Mailing address

7425 Janes Ave
Suite 200
Woodridge, IL 60517-2356
Phone (630) 852-8451

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041122001155 IL Practitioner - Clinical Psychologist 4587629217 Reassigns benefits to 1 organization
Practice locations: Chicago Ridge, IL; Forest Park, IL; Oak Lawn, IL; Richton Park, IL

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Beth Ledvora MD SCGroup PAC ID 4587898754, 7 clinicians

Practice addresses (Care Compare)

7808 W College Dr
Suite 2
Palos Heights, IL 60463-1027
Phone (708) 361-5110

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
071003582ILMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Beth Ledvora M.D. S.C. CurrentSince Sep 1, 2013 Accepting new patients

Locations

7808 W College Dr
Ste 2
Palos Heights, IL 60463
Phone (708) 361-5110

7808 W College Dr
Ste 2W
Palos Heights, IL 60463
Phone (708) 361-5110

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.

NPI Registry JSON

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1871639203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7425 JANES AVE",
            "address_2": "SUITE 200",
            "city": "WOODRIDGE",
            "state": "IL",
            "postal_code": "605172356",
            "telephone_number": "630-852-8451",
            "fax_number": "630-852-0554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7425 JANES AVE",
            "address_2": "SUITE 200",
            "city": "WOODRIDGE",
            "state": "IL",
            "postal_code": "605172356",
            "telephone_number": "630-852-8451",
            "fax_number": "630-852-0554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIEDEL",
        "first_name": "JAMES",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "ED.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodridge, IL

Sources for this page

Verify at the official NPI Registry.