Ryan Robert Pine, M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

036-131048 Issued in IL

Practice address

200 Dettro Dr
Mattoon, IL 61938-9003

Phone

(217) 348-0221

Fax

(217) 345-1380

NPI assigned

May 26, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Ophthalmology

Education

Kansas City University of Physicians and Surgeons, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sarah Bush Lincoln Health CenterGroup PAC ID 5092614867, 411 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sarah Bush Lincoln Health Center Hospital, Mattoon, IL, CCN 140189

Merit-based Incentive Payment System (MIPS)

Final score

92.04 of 100Reported as individual

Quality

100

Improvement activities

40

Cost

73.48

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ryanpinemd@advancedophthalmology.direct.eyemdemr.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.

• Ryan R. Pine, M.D. LTD

  • Specialist
  • Charleston, IL
  • NPI 1700139110
  Medicare reassignment NPD Authorized official
• Sarah Bush Lincoln Health Center

  • General Acute Care Hospital
  • Mattoon, IL
  • NPI 1669564662
  Medicare reassignment Care Compare group NPD
• A William G Schubert MD LTD

  • Ophthalmology Physician
  • Charleston, IL
  • NPI 1932375417
  NPD
• Sarah Bush Lincoln Health Center

  • Rural Health Clinic/Center
  • Greenville, IL
  • NPI 1811858970
  NPD
• Sarah Bush Lincoln Health Center

  • Critical Access Hospital
  • Vandalia, IL
  • NPI 1912988734
  NPD (past)

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

• Sarah Bush Lincoln Health Center

  • General Acute Care Hospital
  • Mattoon, IL
  • NPI 1669564662
  Care Compare affiliation

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

{
    "created_epoch": "1211760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733443200000",
    "number": "1255599452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 372",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619380372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 DETTRO DR",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619389003",
            "telephone_number": "217-348-0221",
            "fax_number": "217-345-1380"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1605 Reynolds Dr",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "IL",
            "postal_code": "619203152",
            "country_code": "US",
            "telephone_number": "217-348-0221",
            "fax_number": "217-345-1380",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PINE",
        "first_name": "RYAN",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-05-26",
        "last_updated": "2024-12-06",
        "certification_date": "2024-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "IL",
            "license": "036-131048",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Petersen Management Company, LLC
• Pharmax Inc.
• Philco Dental Group LLC - Mattoon
• Philip B. Kepp, DDS,PC
• Kali Pierce, BA
• George Issac Plamoottil, M.D.
• Podiatry Medical Surgical Center
• James Samuel Polek
• Anand Ponnappan, MD
• Nora Porter

• Ophthalmology Physician in Mattoon, IL
• Providers in Mattoon, IL by specialty
• Ophthalmology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2024; 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.