Ryan D Pederson, D.P.M.

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

DP151127 Issued in OR

Practice address

1900 Woodland Dr
Coos Bay, OR 97420-2099

Phone

(541) 267-5151

Fax

(541) 266-4506

NPI assigned

Aug 21, 2007

Last updated

Mar 30, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Bend Medical Center IncGroup PAC ID 5597677716, 92 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Bay Area Hospital Hospital, Coos Bay, OR, CCN 380090
• Lower Umpqua Hospital District Hospital, Reedsport, OR, CCN 381311

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rpederson124887@secure.stcharleshealthcare.org
• Direct secure messaging: ryanpederson@southcoast.allscriptsdirect.net

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• North Bend Medical Center Inc

  dba NBMC-Main

  • Multi-Specialty Clinic/Center
  • Coos Bay, OR
  • NPI 1407812365

  Corporate Director

  CMS ownership

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

• North Bend Medical Center Inc

  dba NBMC-Main

  • Multi-Specialty Clinic/Center
  • Coos Bay, OR
  • NPI 1407812365
  Medicare reassignment Care Compare group NPD
• South Coast Orthopaedic Associates, PC

  • Orthopaedic Surgery Physician
  • Coos Bay, OR
  • NPI 1245284751
  Medicare reassignment NPD
• North Bend Medical Center Inc

  dba NBMC-Xray Ekg

  • Diagnostic Radiology Physician
  • Coos Bay, OR
  • NPI 1063428308
  NPD
• Bay Area Hospital District

  dba Bay Area Hospital

  • General Acute Care Hospital
  • Coos Bay, OR
  • NPI 1225016561
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Bay Area Hospital District

  dba Bay Area Hospital

  • General Acute Care Hospital
  • Coos Bay, OR
  • NPI 1225016561
  Care Compare affiliation
• Lower Umpqua Hospital District

  • Critical Access Hospital
  • Reedsport, OR
  • NPI 1003874819
  Care Compare affiliation

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

{
    "created_epoch": "1187654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585526400000",
    "number": "1063605384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 WOODLAND DR",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974202099",
            "telephone_number": "541-269-5151",
            "fax_number": "541-266-4506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 WOODLAND DR",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974202099",
            "telephone_number": "541-267-5151",
            "fax_number": "541-266-4506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSON",
        "first_name": "RYAN",
        "middle_name": "D",
        "credential": "D.P.M.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-08-21",
        "last_updated": "2020-03-30",
        "certification_date": "2020-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "OR",
            "license": "DP151127",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500623170",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Prabhakar Ashokkumar Patel, MD
• Ravindra Patel, M.D.
• Jason Allen Paul, PSS, CRM
• Andrea Paullus, RN, RNFA
• Bhavani Peddagovindu, MD
• Ruth Ann Peet
• Stephanie Perkins, FNP
• David Thomas Petley, PHARM D
• Kristy Leigh Petrie, RN, BSN, FAACM
• Naomi Rachelle Petrie

• Foot & Ankle Surgery Podiatrist in Coos Bay, OR
• Providers in Coos Bay, OR by specialty
• Foot & Ankle Surgery Podiatrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.