Provider Demographics
NPI:1306869557
Name:RIPPERDA, JEFFREY (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:RIPPERDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 CALIFORNIA
Mailing Address - Street 2:P O BOX 577
Mailing Address - City:CARTERVEILL
Mailing Address - State:IL
Mailing Address - Zip Code:62918-0577
Mailing Address - Country:US
Mailing Address - Phone:618-985-8221
Mailing Address - Fax:618-985-4635
Practice Address - Street 1:7 SOUTH HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966-3333
Practice Address - Country:US
Practice Address - Phone:618-687-3418
Practice Address - Fax:618-687-1859
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-116271207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036116271Medicaid
ILCF3444OtherMEDICARE RAILROAD GROUP
ILP00625296OtherMEDICARE RR GROUP PTAN
IL370966854002Medicaid
ILP00625296OtherMEDICARE RR GROUP PTAN
IL036116271Medicaid
IL370966854002Medicaid