Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jacob James Ridder, PA-C

Individual provider Dermatology Physician · NPI 1508291717

Jacob James Ridder, PA-C is a Physician Assistant in Omaha, Nebraska. Qualified in 2013, 13 years ago. Practices with Advanced Dermatology of the Midlands PC, a 7-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Iowa and Nebraska.

Years since qualifying
13
Licensed in
IA, NE
In the registry since
2013
Specialties on file
3
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

12910 Pierce St Ste 120
Omaha, NE 68144-1106
Phone: (402) 933-3770
Fax: (402) 933-3633
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 928 Valley View Dr Ste 10, Council Bluffs, IA 51503-5288 — (402) 933-3770

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence 1768 (NE)
Dermatology Physician Taxonomy 207N00000X · Licence 1768 (NE)
Medical Physician Assistant Taxonomy 363AM0700X · Licence 002439 (IA)

Record details

NPI number1508291717
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedSeptember 6, 2013
Last updated in NPPESJuly 21, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2013 (13 years in practice)
Group practice Advanced Dermatology Of The Midlands Pc — 7 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations6 on file with Medicare

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