Ryan M Bellack, IDMT

Primary specialty

Independent Duty Medical TechniciansTaxonomy code 1710I1003X

Practice address

755 Scott Cir
Hickam Afb, HI 96853-5399

Phone

(808) 430-8898

NPI assigned

Feb 2, 2023

Sex

Male

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1675296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769472000000",
    "number": "1093411902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 BODIN CIR",
            "city": "TRAVIS AFB",
            "state": "CA",
            "postal_code": "945351809",
            "telephone_number": "757-754-3477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "755 SCOTT CIR",
            "city": "HICKAM AFB",
            "state": "HI",
            "postal_code": "968535399",
            "telephone_number": "808-430-8898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BELLACK",
        "first_name": "RYAN",
        "middle_name": "M",
        "credential": "IDMT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-02-02",
        "last_updated": "2026-01-27",
        "certification_date": "2026-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1003X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Medical Technicians",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 15TH Medgrp JBHP-Hickam
• Rodney Valdecanas Acasio, IDMT
• Woody Charles Baker, DDS
• Kenneth Raymond Bellisle, R.PH
• Emily Bien, MD
• Ronald Blasini, MD
• Lucas Gil Borg, DDS
• John Craig Bright, IDMT

• Independent Duty Medical Technicians in Hickam Afb, HI
• Providers in Hickam Afb, HI by specialty
• Independent Duty Medical Technicians in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.