JACOB ISRAEL RYDER LPC
NPI 1104504794
Counselor - Professional in Hampton, VA
About Jacob Israel Ryder Lpc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JACOB ISRAEL RYDER LPC (NPI 1104504794) is an individual professional provider in Hampton, Virginia, licensed in Virginia (0701012308) and active in the NPI registry since July 2023. He is enrolled in Medicare PECOS and is a graduate of Other.
NPPES Registry Identity
Specialties & Licenses 2
Other Identifiers 2
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Jacob Israel Ryder Lpc is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignment
Medicare enrollment records show Jacob Ryder reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Hampton, VA 23666
- Reassigned Medicare billing, Virginia enrollment
- 70 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
HAMPTON, VA 23666
HAMPTON, VA 23666
HAMPTON, VA 23666
HAMPTON, VA 23666
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Jacob Ryder's NPI number?
The NPI number for Jacob Ryder is 1104504794. It was assigned to this individual provider in the NPPES registry on July 5, 2023.
Where is Jacob Ryder located?
Jacob Ryder practices at 200 Medical Dr, Hampton, VA 23666. The listed phone number is (757) 788-0200.
What is Jacob Ryder's specialty?
The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.
Is Jacob Ryder enrolled in Medicare?
Yes. Jacob Ryder is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organization bills Medicare for Jacob Ryder's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Jacob Ryder reassigns Medicare benefits to Hampton Newport News Community Services Board (Hampton, VA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jacob Ryder's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Jacob Ryder was last updated on July 5, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Jacob Israel Ryder, LPC · NPI 1104504794
Professional provider in Hampton, Virginia. Individual provider, active in the CMS NPPES registry since July 5, 2023.
## Identity
- **NPI:** 1104504794 (Entity type: Individual)
- **Enumerated:** July 5, 2023
- **Primary specialty:** Counselor - Professional · taxonomy 101YP2500X
- **State license:** 0701012308 (Virginia)
- **Sole proprietor:** No
## Practice location
- **Address:** 200 MEDICAL DR, Hampton, VA 23666-1763
- **Phone:** (757) 788-0200
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment
- **Bills Medicare through:** Hampton Newport News Community Services Board (NPI 1659424448, Hampton, VA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other
## Record status
- **NPPES last updated:** July 5, 2023
- **Other identifiers:** Other 0710103463 (VA); Other 0701012308 (VA)
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Source: [NPI Profile](https://npiprofile.com/npi/1104504794) · Data from the CMS NPPES public registry.