NPIMap

Individual provider Active NPI

Ryan P McConnell, DO

  • Family Medicine Physician
  • East Jordan, MI
National Provider Identifier
1285625301
Registry record updated Dec 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101013791 Issued in MI
Practice address
601 Bridge St
East Jordan, MI 49727-9383
Phone
(231) 536-2206
Fax
(231) 536-9864
NPI assigned
Oct 31, 2005
Last updated
Dec 21, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 5101013791 MI Primary

Addresses

Primary practice location

601 Bridge St
East Jordan, MI 49727-9383

Mailing address

601 Bridge St
East Jordan, MI 49727-9383
Phone (231) 536-2206

Other identifiers 2

IdentifierTypeStateIssuer
4765816MedicaidMI
P00251496OtherMIRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050622001097 MI Practitioner - Family Practice 1658316484 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Osteopathic Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
McKenzie Memorial HospitalGroup PAC ID 6406755289, 31 clinicians

Practice addresses (Care Compare)

120 N Delaware St
Sandusky, MI 48471-1009
Phone (810) 648-6162

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Michigan Emergency Physicians PC CurrentSince Nov 15, 2017 Accepting new patients
Munson Medical Center Current Accepting new patients
Northern Michigan Emergency Physicians, LLP CurrentSince Nov 20, 2017 Accepting new patients
Munson Medical Center CurrentSince Sep 28, 2004 Accepting new patients
McKenzie Memorial Hospital CurrentSince Nov 13, 2018 Accepting new patients
McKenzie Memorial Hospital CurrentSince Nov 13, 2018 Accepting new patients
Munson Medical Center CurrentSince Sep 28, 2004 Accepting new patients
Northern Michigan Emergenc Physicians, LLP CurrentSince Nov 20, 2017 Accepting new patients
Home Care Physician PC Past Accepting new patients
Heritage Medical Group Past Accepting new patients
Munson Healthcare Otsego Memorial Hospital Past Accepting new patients

Locations

2513 Momentum Pl
Chicago, IL 60689
Phone (231) 935-8031

14700 Lake Shore Dr
Charlevoix, MI 49720
Phone (231) 547-3840

3401 Ludington St
Escanaba, MI 49829
Phone (906) 786-3311

1140 N State St
Saint Ignace, MI 49781
Phone (906) 643-0466

120 N Delaware St
Sandusky, MI 48471
Phone (810) 648-3770

1105 Sixth St
Traverse City, MI 49684
Phone (231) 922-9000

1400 Medical Campus Dr
Traverse City, MI 49684
Phone (231) 935-8000

550 Munson Ave
Traverse City, MI 49686
Phone (231) 935-6600

2463 S M 30
West Branch, MI 48661
Phone (517) 345-3660

Organizations & group practices 11

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 2

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": "1130716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513814400000",
    "number": "1285625301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 BRIDGE ST",
            "city": "EAST JORDAN",
            "state": "MI",
            "postal_code": "497279383",
            "telephone_number": "231-536-2206",
            "fax_number": "231-536-9864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 BRIDGE ST",
            "city": "EAST JORDAN",
            "state": "MI",
            "postal_code": "497279383",
            "telephone_number": "231-536-2206",
            "fax_number": "231-536-9864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCONNELL",
        "first_name": "RYAN",
        "middle_name": "P",
        "name_prefix": "Mr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-31",
        "last_updated": "2017-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101013791",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4765816",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00251496",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in East Jordan, MI

Sources for this page

Verify at the official NPI Registry.