Victoria Eleanor Ryan, PA-C

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

PA-626 Issued in ID

Practice address

990 Cesar Chavez Ave
Pocatello, ID 83209-0001

Phone

(208) 282-2330

NPI assigned

Nov 20, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Family Practice Group, P.a.

  • Family Medicine Physician
  • Pocatello, ID
  • NPI 1205869310

  ID

  Medicare reassignment
• Family Practice Group, P.a.

  • Cardiac Rehabilitation Clinic/Center
  • Pocatello, ID
  • NPI 1912723214
  NPD
• Idaho State University Health Center

  • Student Health Clinic/Center
  • Pocatello, ID
  • NPI 1336214618
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441843200000",
    "number": "1003980210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "990 CESAR CHAVEZ AVE",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832090001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "990 CESAR CHAVEZ AVE",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832090001",
            "telephone_number": "208-282-2330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYAN",
        "first_name": "VICTORIA",
        "middle_name": "ELEANOR",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-20",
        "last_updated": "2015-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "ID",
            "license": "PA-626",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madison Russell
• Robin Rutherford, COTA
• Carol Ruud
• Ryan D. Hope, M.D., LLC
• Kenneth Ryan, MD
• S. Jeff Bray, DPM, Inc.
• William G Sabel, FNP
• Safe Haven Health Care LLC
• Safe Haven Health Care LLC
• Lizette Salgado

• Student in an Organized Health Care Education/Training Program in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Student in an Organized Health Care Education/Training Program in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.