Individual provider Active NPI

Ryan Fairley

  • Surgery Physician
  • Portland, OR
National Provider Identifier
1144606229
Registry record updated Jul 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
DO197810 Issued in OR
Practice address
1040 NW 22ND Ave Ste 520
Portland, OR 97210-3097
Phone
(503) 413-7557
NPI assigned
Jul 30, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X DO197810 OR Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

1040 NW 22ND Ave Ste 520
Portland, OR 97210-3097

Mailing address

PO Box 3808
Portland, OR 97208-3808

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20211018001805 VA Practitioner - General SurgeryPractitioner - Other (Physician) 4981027612 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
MCV Associated PhysiciansGroup PAC ID 4385542117, 1,779 clinicians

Practice addresses (Care Compare)

1001 E Leigh St
Richmond, VA 23298-5004
Phone (804) 828-7929

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.95 of 100Reported as group
Quality
69.91
Promoting interoperability
99
Improvement activities
40
Cost
77.42

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)12
Upper gastrointestinal (GI) endoscopy for acid reflux29

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
DO197810ORMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
MCV Associated Physicians Single Specialty CurrentSince Sep 1, 2021 Accepting new patients

Locations

1250 E Marshall St
Richmond, VA 23298
Phone (804) 628-6990

9109 Stony Point Dr
Richmond, VA 23235
Phone (804) 827-8000

1001 E Leigh St
Richmond, VA 23298
Phone (804) 628-7497

401 N 11th St
Richmond, VA 23219
Phone (804) 828-4409

659 Hospital Rd
Ste 203
Tappahannock, VA 22560
Phone (804) 443-6232

Organizations & group practices 1

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.

Hospital & facility affiliations 3

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": "1438214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594166400000",
    "number": "1144606229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3808",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 NW 22ND AVE STE 520",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972103097",
            "telephone_number": "503-413-7557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIRLEY",
        "first_name": "RYAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-07-30",
        "last_updated": "2020-07-08",
        "certification_date": "2020-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "OR",
            "license": "DO197810",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.