Individual provider Active NPI

Scott J Cryder, PA-C

  • Surgical Physician Assistant
  • Logan, OH
National Provider Identifier
1215018205
Registry record updated Feb 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
50002332 Issued in OH
Practice address
819 State Route 664 N
Logan, OH 43138
Phone
(740) 380-8140
Fax
(740) 380-8150
NPI assigned
Oct 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X 50002332 OH Primary

Addresses

Primary practice location

819 State Route 664 N
Logan, OH 43138

Mailing address

PO Box 228
Logan, OH 43138-0228
Phone (740) 380-4181

Other practice location 1

31490 Chieftain Dr
Suite A
Logan, OH 43138-8420
Phone (740) 385-8474

Other practice location 2

1141 N Monroe Dr
Xenia, OH 45385-1619
Phone (937) 374-4036

Other identifiers 3

IdentifierTypeStateIssuer
2330150MedicaidOH
000000547134OtherOHANTHEM
2553018OtherOHUHC

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address scryder708373@direct.ketteringhealth.org
FHIR URL https://khnarr.ketthealth.com/FHIR-PROD/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20061212000430 OH Practitioner - Physician Assistant 0244239606 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kettering Independent Medical Group IncGroup PAC ID 3173710936, 699 clinicians

Practice addresses (Care Compare)

3535 Pentagon Blvd
Beavercreek, OH 45431-1705

3535 Pentagon Park Blvd
Suite 400
Dayton, OH 45431-1705
Phone (937) 490-2264

4403 Far Hills Ave
Kettering, OH 45429-2405
Phone (937) 433-5309

4441 Far Hills Ave
Kettering, OH 45429-2405
Phone (937) 298-7751

Hospital & facility affiliations

  • Kettering Health Greene Memorial Hospital, Xenia, OH, CCN 360026
  • Soin Medical Center Hospital, Beaver Creek, OH, CCN 360360
  • Kettering Health Dayton Hospital, Dayton, OH, CCN 360133

Merit-based Incentive Payment System (MIPS)

Final score
81.34 of 100Reported as group
Quality
63.67
Promoting interoperability
100
Improvement activities
40
Cost
74.14

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
50002332OHMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Alliance Physicians Inc CurrentSince Jan 27, 2020 Accepting new patients
Alliance Physicians Inc CurrentSince Jan 27, 2020 Accepting new patients

Locations

3535 Pentagon Blvd
Ste 320
Beavercreek, OH 45431
Phone (937) 490-2270

7740 Washington Village Dr
Ste 130
Dayton, OH 45459
Phone (513) 932-4891

4403 Far Hills Ave
Kettering, OH 45429
Phone (937) 395-3910

1 Prestige Pl
Ste 550
Miamisburg, OH 45342
Phone (937) 752-2306

2100 Emmanuel Way
Ste E
Springfield, OH 45502
Phone (866) 224-9472

1625 S Alex Rd
West Carrollton, OH 45449
Phone (937) 865-0534

1141 N Monroe Dr
Xenia, OH 45385
Phone (937) 352-2000

1141 N Monroe Dr
#T
Xenia, OH 45385

50 N Progress Dr
Xenia, OH 45385
Phone (937) 352-2850

Organizations & group practices 3

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": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612137600000",
    "number": "1215018205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 228",
            "city": "LOGAN",
            "state": "OH",
            "postal_code": "431380228",
            "telephone_number": "740-380-4181",
            "fax_number": "740-385-0865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "819 STATE ROUTE 664 N",
            "city": "LOGAN",
            "state": "OH",
            "postal_code": "43138",
            "telephone_number": "740-380-8140",
            "fax_number": "740-380-8150"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "31490 Chieftain Dr",
            "address_2": "Suite A",
            "address_purpose": "LOCATION",
            "city": "Logan",
            "state": "OH",
            "postal_code": "431388420",
            "country_code": "US",
            "telephone_number": "740-385-8474",
            "fax_number": "740-385-5095",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1141 N Monroe Dr",
            "address_purpose": "LOCATION",
            "city": "Xenia",
            "state": "OH",
            "postal_code": "453851619",
            "country_code": "US",
            "telephone_number": "937-374-4036",
            "fax_number": "937-374-4034",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CRYDER",
        "first_name": "SCOTT",
        "middle_name": "J",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-18",
        "last_updated": "2021-02-01",
        "certification_date": "2021-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OH",
            "license": "50002332",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2330150",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000547134",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "2553018",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "scryder708373@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "1141 N Monroe Dr",
            "city": "Xenia",
            "state": "OH",
            "country_code": "US",
            "postal_code": "453851619",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://khnarr.ketthealth.com/FHIR-PROD/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "1141 N Monroe Dr",
            "city": "Xenia",
            "state": "OH",
            "country_code": "US",
            "postal_code": "453851619",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Logan, OH

Sources for this page

Verify at the official NPI Registry.