Individual provider Active NPI

Ryan Casey Nulph, P.A.-C.

  • Physician Assistant
  • Dallas, TX
National Provider Identifier
1174852693
Registry record updated Nov 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA06696 Issued in TX
Practice address
12221 Merit Dr Ste 1610
Dallas, TX 75251-2204
Phone
(214) 217-1911
Fax
(214) 217-1912
NPI assigned
Dec 11, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X PA06696 TX Primary

Addresses

Primary practice location

12221 Merit Dr Ste 1610
Dallas, TX 75251-2204

Mailing address

12221 Merit Dr Ste 1610
Dallas, TX 75251-2204
Phone (214) 217-1911

Other identifiers 3

IdentifierTypeStateIssuer
283189301MedicaidTX
283189302MedicaidTX
283189303MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20110503000103 TX Practitioner - Physician Assistant 4789869900 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA06696TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Questcare Medical Services, PLLC Physician Assistant CurrentSince Feb 1, 2010 Accepting new patients
Questcare Medical Services, PLLC Physician Assistant CurrentSince Feb 1, 2010 Accepting new patients
Texas Em-1 Medical Services, PA Past Accepting new patients

Locations

3301 Matlock Rd
Arlington, TX 76015
Phone (682) 509-6200

7777 Forest Ln
Dallas, TX 75230
Phone (972) 566-7283

3901 W 15th St
Plano, TX 75075
Phone (972) 519-1115

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1260489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321833600000",
    "number": "1174852693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12221 MERIT DR STE 1610",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752512204",
            "telephone_number": "214-217-1911",
            "fax_number": "214-217-1912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12221 MERIT DR STE 1610",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752512204",
            "telephone_number": "214-217-1911",
            "fax_number": "214-217-1912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NULPH",
        "first_name": "RYAN",
        "middle_name": "CASEY",
        "credential": "P.A.-C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-12-11",
        "last_updated": "2011-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA06696",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "283189301",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "283189302",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "283189303",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.