Individual provider Active NPI

Ryan Newberger, M.D.

  • Emergency Medicine Physician
  • Peoria, IL
National Provider Identifier
1073046553
Registry record updated Apr 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
0000000000 Issued in IL
Practice address
530 NE Glen Oak Ave
Peoria, IL 61637-0001
Phone
(248) 207-2018
NPI assigned
Apr 11, 2017
Last updated
Apr 11, 2017By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 11, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 0000000000 IL Primary

Addresses

Primary practice location

530 NE Glen Oak Ave
Peoria, IL 61637-0001

Mailing address

530 NE Glen Oak Ave
Peoria, IL 61637-0001
Phone (248) 207-2018

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200720000142 MI Practitioner - Emergency Medicine 6709150402 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
McLaren Hospital GroupGroup PAC ID 2365968351, 366 clinicians
McLaren Medical GroupGroup PAC ID 3971416082, 240 clinicians

Practice addresses (Care Compare)

2900 Collins Rd
Lansing, MI 48910-8394
Phone (517) 975-7500

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
0000000000ILMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
McLaren Medical Group CurrentSince Aug 2, 2023 Accepting new patients
Degara App, PLLC Emergency Medicine CurrentSince Jul 6, 2020 Accepting new patients
McLaren Medical Group Emergency Medicine CurrentSince Aug 2, 2023 Accepting new patients
McLaren Hospital Group Emergency Medicine CurrentSince Aug 1, 2025 Accepting new patients

Locations

39373 Garfield Rd
Clinton Twp, MI 48038
Phone (586) 286-4880

401 S Ballenger Hwy
Flint, MI 48532
Phone (810) 342-1000

2900 Collins Rd
Lansing, MI 48910
Phone (517) 975-7500

401 W Greenlawn Ave
Lansing, MI 48910
Phone (517) 334-2286

50 N Perry St
Pontiac, MI 48342
Phone (248) 338-5300

5121 Maryland Way
Ste 300
Brentwood, TN 37027
Phone (615) 436-6556

Organizations & group practices 4

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1491868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491868800000",
    "number": "1073046553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616370001",
            "telephone_number": "248-207-2018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616370001",
            "telephone_number": "248-207-2018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEWBERGER",
        "first_name": "RYAN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-04-11",
        "last_updated": "2017-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "0000000000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.