MR. JERRY RIDER (NPI# 1194884494) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194884494 |
| Entity Type | Individual |
| Full Name | MR. JERRY RIDER |
| Credential | PA-C |
| Practice Address |
501 Northcrest Dr Springfield TN 37172-4065 |
| Practice Telephone | 6153825204 |
| Practice Fax Number | 6153824952 |
| Mailing Telephone | 6153825204 |
| Mailing Fax Number | 6153824952 |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2014-11-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
501 NORTHCREST DR |
| City | SPRINGFIELD |
| State | TN |
| Zip Code | 37172-4065 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215922711 | George A Dahir | Orthopaedic Surgery | 501 Northcrest Dr, Springfield, TN 37172-4065 | 2005-09-12 |
| 1720079478 | William F Beauchamp | Orthopaedic Surgery | 501 Northcrest Dr, Springfield, TN 37172-3973 | 2005-11-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447859376 | Results-ast Jv, LLC | Physical Therapist | 3556 Tom Austin Highway, Suite 2, Springfield, TN 37172 | 2020-10-21 |
| 1871107482 | Springfield Residential, LLC | Assisted Living Facility | 2530 South Main Street, Springfield, TN 37172 | 2020-09-01 |
| 1922610427 | Jenae Annette Rankin | Physical Therapist | Intelligent Therapy, 719 South Main Street, Springfield, TN 37172 | 2020-08-18 |
| 1043856297 | Jeffrey Brian Barnes | Pharmacist | 100 Northcrest Dr., Pharmacy, Springfield, TN 37172 | 2019-11-22 |
| 1407407968 | Sadie L Shields | Speech-Language Pathologist | Its 3131 Tom Austin Highway, Springfield, TN 37172 | 2019-09-26 |
| 1871148965 | Austin Chhut | Occupational Therapy Assistant | Intelligent Therapy Staffing, 3131 Tom Austin Hwy, Springfield, TN 37172 | 2019-08-06 |
| 1013409887 | Springfield Pediatric Dentistry | Dentist | 3130 Tom Austin Hwy Ste B, Springfield, TN 37172 | 2018-06-06 |
| 1083163752 | The Ridge | Counselor | 514 Hill Street, Springfield, TN 37172 | 2016-09-23 |
| 1902255516 | Dionna Marino | Case Manager/Care Coordinator | 731 Cheatham Street, Springfield, TN 37172 | 2016-06-06 |
| 1174964258 | Molly Williams | Registered Nurse | 800 S. Brown Street, Springfield, TN 37172 | 2013-07-17 |
| Find all providers in zip 37172 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629592225 | Justin William Starling | Physician Assistant | 1515 Keys Ave, Springfield, IL 62702-2933 | 2017-07-26 |
| 1710435011 | Alexander Andersen | Physician Assistant | 445 Harlow Rd Ste 200, Springfield, OR 97477-1341 | 2016-09-14 |
| 1932538980 | Emily Baecher | Physician Assistant | 2 Medical Cetner Dr, Suite 205, Springfield, MA 01199-1619 | 2013-11-09 |
| 1699114421 | Lauren M Kendall | Physician Assistant | 960 N 16th St Ste 108, Springfield, OR 97477-4175 | 2013-06-14 |
| 1750660148 | Daniel Francis Reilly Jr. | Physician Assistant | 2 Medical Center Dr Ste 308, Springfield, MA 01107-1271 | 2011-08-16 |
| 1831499383 | Christin Wolak | Physician Assistant | 300 Birnie Ave Ste 201, Springfield, MA 01107-1121 | 2010-11-01 |
| 1811200710 | Jessica Anne White | Physician Assistant | 25 Ridgewood Rd., Esne, Springfield, VT 05156 | 2010-07-20 |
| 1043540669 | Kristen Dawn Dodd | Physician Assistant | 960 N 16th St Ste 207, Springfield, OR 97477-4175 | 2010-01-04 |
| 1831337765 | Cynthia R. Krinochkin | Physician Assistant | 3801 S. National, 5th Floor, Springfield, MO 65807-5210 | 2009-01-30 |
| 1578746079 | Jamie Moore | Physician Assistant | 2 Medical Center Drive Suite 503, Springfield, MA 01199-0001 | 2007-12-07 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 37172 |
Please comment or provide details below to improve the information on MR. JERRY RIDER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.