This study contributes to the ongoing discussion of Mathematical Knowledge for Teaching (MKT). It investigates the case of Rico, a high school mathematics teacher who had become known to his colleagues and his students as a superbly effective mathematics teacher. His students not only developed excellent mathematical skills, they also developed deep understanding of the mathematics they learned. Moreover, Rico redesigned his curricula and instruction completely so that they provided a means of support for his students to learn mathematics the way he intended. The purpose of this study was to understand the sources of Rico's effectiveness. The data for this study was generated in three phases. Phase I included videos of Rico's lessons during one semester of an Algebra II course, post-lesson reflections, and Rico's self-constructed instructional materials. An analysis of Phase I data led to Phase II, which consisted of eight extensive stimulated-reflection interviews with Rico. Phase III consisted of a conceptual analysis of the prior phases with the aim of creating models of Rico's mathematical conceptions, his conceptions of his students' mathematical understandings, and his images of instruction and instructional design. Findings revealed that Rico had developed profound personal understandings, grounded in quantitative reasoning, of the mathematics that he taught, and profound pedagogical understandings that supported these very same ways of thinking in his students. Rico's redesign was driven by three factors: (1) the particular way in which Rico himself understood the mathematics he taught, (2) his reflective awareness of those ways of thinking, and (3) his ability to envision what students might learn from different instructional approaches. Rico always considered what someone might already need to understand in order to understand "this" in the way he was thinking of it, and how understanding "this" might help students understand related ideas or methods. Rico's continual reflection on the mathematics he knew so as to make it more coherent, and his continual orientation to imagining how these meanings might work for students' learning, made Rico's mathematics become a mathematics of students--impacting how he assessed his practice and engaging him in a continual process of developing MKT.