Kellie Marie Ryan - Wilson, CNM

Primary specialty

Advanced Practice MidwifeTaxonomy code 367A00000X

License

AP111628 Issued in TX

Practice address

220 E. Harris
San Angelo, TX 76903

Phone

(325) 658-1511

Fax

(325) 481-2165

NPI assigned

Apr 6, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Kellie Ryan Former name

Medicare fee-for-service enrollment

Enrolled in TX2 enrollments

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 2

Specialty

Certified Nurse Midwife (CNM)

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Shannon ClinicGroup PAC ID 0840103727, 550 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Shannon Medical Center Hospital, San Angelo, TX, CCN 450571

Merit-based Incentive Payment System (MIPS)

Final score

82.63 of 100Reported as group

Quality

78.21

Promoting interoperability

96

Improvement activities

40

Cost

67.22

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Midwife, Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kryan6761@shannonhealth.direct-ci.com

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.

• Shannon Clinic

  • Family Medicine Physician
  • San Angelo, TX
  • NPI 1770587149
  Medicare reassignment Care Compare group NPD
• Obhg Texas Holdings, P.a.

  • Obstetrics & Gynecology Physician
  • Austin, TX
  • NPI 1083917769
  Medicare reassignment NPD
• Shannon Medical Center

  • General Acute Care Hospital
  • San Angelo, TX
  • NPI 1992707228
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Shannon Medical Center

  • General Acute Care Hospital
  • San Angelo, TX
  • NPI 1992707228
  Care Compare affiliation

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

{
    "created_epoch": "1144281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608249600000",
    "number": "1255393872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22000",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "769027200",
            "telephone_number": "325-658-1511",
            "fax_number": "325-481-2165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 E. HARRIS",
            "city": "SAN ANGELO",
            "state": "TX",
            "postal_code": "76903",
            "telephone_number": "325-658-1511",
            "fax_number": "325-481-2165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYAN - WILSON",
        "first_name": "KELLIE",
        "middle_name": "MARIE",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-06",
        "last_updated": "2020-12-18",
        "certification_date": "2020-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "TX",
            "license": "AP111628",
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "TX",
            "license": "AP111628",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "170388603",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8Y3124",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLIE",
            "last_name": "RYAN",
            "credential": "CNP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ingrid Angela Russo, MSW, LCSW
• Harvey D Russwurm, MD
• Nicole Schmoll Russwurm, M.S. CCC-SLP
• Amy Rutherford, M. ED., LPC
• Mallory Rochelle Ryalls
• Ryan L Montgomery DDS MD PLLC (Angelo Oral and Maxillofacial Surgery)
• Vernon L Ryan, MD
• S. Harding, DDS, P.a. (Affordable Dentures & Implants - San Angelo)
• Sa-Oms Specialists
• Samantha Sablan, RBT

• Advanced Practice Midwife in San Angelo, TX
• Providers in San Angelo, TX by specialty
• Advanced Practice Midwife in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2020; 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.

Verify at the official NPI Registry.