Ryan Blair Killpack, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

98 Poplar St
Blackfoot, ID 83221-1758

Phone

(208) 785-4100

NPI assigned

Jul 31, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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

Specialty

Physician Assistant

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

BMH IncGroup PAC ID 8426149758, 137 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Bingham Memorial Hospital Hospital, Blackfoot, ID, CCN 131325

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ryankillpack@bmh.medalliesdirect.net

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.

• BMH Inc

  • Critical Access Hospital
  • Blackfoot, ID
  • NPI 1982805271
  Medicare reassignment Care Compare group NPD
• BMH, Inc.

  • Surgery Physician
  • Blackfoot, ID
  • NPI 1255539193
  Medicare reassignment
• BMH, Inc.

  • Family Medicine Physician
  • Pocatello, ID
  • NPI 1295502995
  NPD
• BMH Inc.

  • Rural Health Clinic/Center
  • Blackfoot, ID
  • NPI 1770785875
  NPD (past)

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

• BMH Inc

  • Critical Access Hospital
  • Blackfoot, ID
  • NPI 1982805271
  Care Compare affiliation

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

{
    "created_epoch": "1532995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532995200000",
    "number": "1114405396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "98 POPLAR ST",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832211758",
            "telephone_number": "208-785-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "98 POPLAR ST",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832211758",
            "telephone_number": "208-785-4100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KILLPACK",
        "first_name": "RYAN",
        "middle_name": "BLAIR",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-31",
        "last_updated": "2018-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon Jones, COTA/L
• Anita Kadikar, MD
• James Taylor Kelley, PHARMD
• Michele Kelly, LCSW
• Mark A Kennington, DC
• Taras P. Kindrat, MD
• Brianne Lynn Larson, LMSW
• Steven Larson, DO
• Stefney Layton
• Kabrina Kay Leavitt, FNP-BC

• Medical Physician Assistant in Blackfoot, ID
• Providers in Blackfoot, ID by specialty
• Medical Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2018; 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.
• 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.