Active NPI
Justin Ryan, FNP-C
- Family Nurse Practitioner
- Lambertville, MI
National Provider Identifier
1174148712
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 4704350098
- Practice address
- 3175 Smith Rd
Lambertville, MI 48144-9434 - Phone
- (734) 856-5494
- NPI assigned
- Jun 9, 2020
- Last updated
- Nov 3, 2023
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 4704350098 | MI | Primary |
| Registered Nurse | 163W00000X | RN.404739 | OH | |
| Registered Nurse | 163W00000X | 4704350098 | MI |
Addresses
Primary practice location
3175 Smith Rd
Lambertville, MI 48144-9434
Mailing address
3175 Smith Rd
Lambertville, MI 48144-9434
Phone (734) 856-5494
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jryan34061@epicdirect.promedica.org |
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: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- University of Toledo College of Medicine, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
3175 Smith Rd
Lambertville, MI 48144-9434
Phone (734) 856-5494
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN.404739 | OH | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Promedica Monroe Physicians | Current | Accepting new patients |
Locations
3175 Smith Rd
Lambertville, MI 48144
Phone (734) 856-5494
100 Madison Ave
Toledo, OH 43604
Phone (567) 585-1964
Interoperability endpoints
- jryan34061@direct.promedica.org
- jryan34061@epicdirect.promedica.org
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Promedica Monroe Regional Hospital
- General Acute Care Hospital
- Monroe, MI
- NPI 1811097223
-
dba Monroe Cancer Center
- Specialist
- Monroe, MI
- NPI 1376997551
Hospital
-
- Home Health Agency
- Monroe, MI
- NPI 1336414325
-
- General Acute Care Hospital
- Toledo, OH
- NPI 1407854771
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1591660800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1698969600000",
"number": "1174148712",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3175 SMITH RD",
"city": "LAMBERTVILLE",
"state": "MI",
"postal_code": "481449434",
"telephone_number": "734-856-5494"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3175 SMITH RD",
"city": "LAMBERTVILLE",
"state": "MI",
"postal_code": "481449434",
"telephone_number": "734-856-5494"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RYAN",
"first_name": "JUSTIN",
"credential": "FNP-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-06-09",
"last_updated": "2023-11-03",
"certification_date": "2020-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MI",
"license": "4704350098",
"primary": true
},
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "OH",
"license": "RN.404739",
"primary": false
},
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MI",
"license": "4704350098",
"primary": false
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "jryan34061@epicdirect.promedica.org",
"affiliation": "N",
"address_1": "100 Madison Ave",
"city": "Toledo",
"state": "OH",
"country_code": "US",
"postal_code": "436041516",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Lambertville, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2023; 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.