NPIMap

Individual provider Active NPI

Jonathan Van Buren Riddell, MD

  • Pediatric Urology Physician
  • Syracuse, NY
National Provider Identifier
1922391077
Registry record updated Jul 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Urology PhysicianTaxonomy code 2088P0231X
License
270264 Issued in NY
Practice address
750 E Adams St
Syracuse, NY 13210-2342
Phone
(315) 464-6106
Fax
(315) 464-6107
NPI assigned
May 24, 2011
Last updated
Jul 19, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 270264 NY
Pediatric Urology Physician 2088P0231X 270264 NY Primary

Addresses

Primary practice location

750 E Adams St
Syracuse, NY 13210-2342

Mailing address

750 E Adams St
Syracuse, NY 13210-2342
Phone (315) 464-6106

Other identifiers 1

IdentifierTypeStateIssuer
03340452MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, ID2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110610000171 NY Practitioner - Urology 4789861204 Reassigns benefits to 4 organizations
I20260105001744 ID Practitioner - Urology 4789861204 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Adirondack Medical CenterGroup PAC ID 9638081284, 85 clinicians

Practice addresses (Care Compare)

2233 State Route 86
Saranac Lake, NY 12983-5644
Phone (518) 891-4141

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection26
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
003768NYMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
Upstate Urology, Inc. Urology CurrentSince May 24, 2011 Accepting new patients
Champlain Valley Physicians Hospital Medical Center CurrentSince May 1, 2020 Accepting new patients
Adirondack Medical Center Urology CurrentSince Mar 1, 2023 Accepting new patients
St Lukes Clinic-Treasure Valley LLC Urology CurrentSince Nov 18, 2025 Accepting new patients
Adirondack Medical Center CurrentSince Mar 1, 2023 Accepting new patients
United Health Services Hospitals, Inc. CurrentSince Jul 1, 2017 Accepting new patients
St Lukes Regional Medical Center Past Accepting new patients
Adirondack Medical Center Past Accepting new patients

Locations

305 E Jefferson St
Boise, ID 83712
Phone (208) 381-7081

610 W Hays St
Boise, ID 83702
Phone (208) 345-3530

30 Harrison St
Ste 460
Johnson City, NY 13790
Phone (607) 763-8101

29 Church St
Lake Placid, NY 12946
Phone (518) 523-1327

75 Beekman St
Plattsburgh, NY 12901
Phone (518) 562-7100

2233 State Route 86
Saranac Lake, NY 12983
Phone (518) 891-4141

4900 Broad Rd
Ste 2I
Syracuse, NY 13215
Phone (315) 464-6106

750 E Adams St
Syracuse, NY 13210
Phone (315) 464-4363

7 Stetson Rd
Tupper Lake, NY 12986
Phone (518) 359-7000

111 Colchester Ave
Burlington, VT 05401
Phone (802) 656-2415

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 7

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": "1306195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1374192000000",
    "number": "1922391077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 E ADAMS ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102342",
            "telephone_number": "315-464-6106",
            "fax_number": "315-464-6107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 E ADAMS ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102342",
            "telephone_number": "315-464-6106",
            "fax_number": "315-464-6107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIDDELL",
        "first_name": "JONATHAN",
        "middle_name": "VAN BUREN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-05-24",
        "last_updated": "2013-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NY",
            "license": "270264",
            "primary": false
        },
        {
            "code": "2088P0231X",
            "taxonomy_group": "",
            "desc": "Urology, Pediatric Urology",
            "state": "NY",
            "license": "270264",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03340452",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

Verify at the official NPI Registry.