Active NPI
Ryan Vandermark, PA-C
- Physician Assistant
- Harrisburg, PA
National Provider Identifier
1144749631
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- MA059266
- Practice address
- 4300 Londonderry Rd
Harrisburg, PA 17109-5317 - Phone
- (717) 988-0000
- Fax
- (717) 782-5716
- NPI assigned
- Sep 15, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | MA059266 | PA | Primary |
Addresses
Primary practice location
4300 Londonderry Rd
Harrisburg, PA 17109-5317
Mailing address
409 S 2ND St Ste 2F
Harrisburg, PA 17104-1612
Phone (717) 988-0000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 103393764 | Medicaid | PA |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | rvandermark57109@phsdirect.pinnaclehealth.org |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA, NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- State University of New York at Stony Brook, School of Medicine, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1367 Washington Ave
Suite 200
Albany, NY 12206-1043
Phone (518) 489-2666
4 Medical Park Dr
Suite 200
Malta, NY 12020-5004
Phone (518) 289-2171
989 Route 146
Suite 200
Clifton Park, NY 12065-3647
Phone (518) 383-0617
Hospital & facility affiliations
Merit-based Incentive Payment System (MIPS)
- Final score
- 82.41 of 100
- Quality
- 56.02
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 85.34
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10375 | GA | MD | General Practice Dentistry |
| 028313 | NY | MD | Pharmacist |
Interoperability endpoints
- ryan.vandermark.1@28317.direct.athenahealth.com
- rvandermark1846001@direct.trinity-health.org
Organizations & group practices 2
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.
-
- Orthopaedic Surgery Physician
- Albany, NY
- NPI 1871533216
-
- Emergency Medicine Physician
- Harrisburg, PA
- NPI 1487693404
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Ambulatory Surgical Clinic/Center
- Niskayana, NY
- NPI 1154973071
Hospital
-
- General Acute Care Hospital
- Albany, NY
- NPI 1376577247
-
dba Albany Medical Center South Clinical Campus
- General Acute Care Hospital
- Albany, NY
- NPI 1811917461
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1505433600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1610150400000",
"number": "1144749631",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "409 S 2ND ST STE 2F",
"city": "HARRISBURG",
"state": "PA",
"postal_code": "171041612",
"telephone_number": "717-988-0000",
"fax_number": "717-782-5716"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4300 LONDONDERRY RD",
"city": "HARRISBURG",
"state": "PA",
"postal_code": "171095317",
"telephone_number": "717-988-0000",
"fax_number": "717-782-5716"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDERMARK",
"first_name": "RYAN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-09-15",
"last_updated": "2021-01-09",
"certification_date": "2021-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "PA",
"license": "MA059266",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "103393764",
"state": "PA"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "rvandermark57109@phsdirect.pinnaclehealth.org",
"affiliation": "N",
"address_1": "4300 Londonderry Rd",
"city": "Harrisburg",
"state": "PA",
"country_code": "US",
"postal_code": "171095317",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Harrisburg, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2021; 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.