Kenneth Riddle III

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

PC007823 Issued in PA

Practice address

135 Technology Dr Ste 312
Canonsburg, PA 15317-9549

Phone

(724) 413-4306

NPI assigned

Jul 15, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

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

Specialty

Mental Health Counselor

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

MLS Mindful Therapy PCGroup PAC ID 2961823703, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• MLS Mindful Therapy PC

  • Clinical Social Worker
  • Canonsburg, PA
  • NPI 1790307130
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1626307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706572800000",
    "number": "1962074203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 TECHNOLOGY DR STE 312",
            "city": "CANONSBURG",
            "state": "PA",
            "postal_code": "153179549",
            "telephone_number": "724-413-4306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 TECHNOLOGY DR STE 312",
            "city": "CANONSBURG",
            "state": "PA",
            "postal_code": "153179549",
            "telephone_number": "724-413-4306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIDDLE",
        "first_name": "KENNETH",
        "name_suffix": "III",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-15",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "PA",
            "license": "PC007823",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Marie Reiser, M.S., LPC, NCC
• Rest Haven Personal Care Home
• Retirement Village of North Strabane Facility Operations, LLC
• Christopher Edgar Rhody, DO
• Girish Himmatlal Ribadiya, M.D.
• Kaitlyn Renee Riggle, LPC
• Rite Aid of Pennsylvania LLC
• Jennifer Rittenhouse-Puhak, M.D.
• Robert Evans DDS
• Leonard E Robinson III, PA-C

• Professional Counselor in Canonsburg, PA
• Providers in Canonsburg, PA by specialty
• Professional Counselor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.