NPIMap

Individual provider Active NPI

Ryan Timothy Bly, MD

  • Surgery Physician
  • Kalamazoo, MI
National Provider Identifier
1295170231
Registry record updated Jul 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
69044 Issued in WI
Practice address
1000 Oakland Dr
Kalamazoo, MI 49008-1282
Phone
(269) 337-4400
NPI assigned
May 3, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 69044 WI Primary

Addresses

Primary practice location

1000 Oakland Dr
Kalamazoo, MI 49008-1282

Mailing address

100 Theda Clark Medical PLZ
Ste 400
Neenah, WI 54956-2763
Phone (920) 725-4527

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20180801002515 WI Practitioner - General Surgery 1951531953 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Surgical Associates of Neenah, S.C.Group PAC ID 4486625258, 29 clinicians

Practice addresses (Care Compare)

100 Theda Clark Medical PLZ
Suite 400
Neenah, WI 54956-2763
Phone (920) 725-4527

Hospital & facility affiliations

  • Thedacare at Home Hospice, Appleton, WI, CCN 521504
  • Thedacare Regional Med Ctr - Neenah Hospital, Neenah, WI, CCN 520045
  • Thedacare Medical Center - Berlin Inc Hospital, Berlin, WI, CCN 521355
  • Thedacare Regional Medical Center - Appleton Inc Hospital, Appleton, WI, CCN 520160

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy30
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux33
Removal of tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Surgical Associates of Neenah, S.C. Surgery CurrentSince Aug 1, 2018 Accepting new patients

Locations

100 Theda Clark Medical Plz
Neenah, WI 54956
Phone (920) 722-7747

100 Theda Clark Medical Plz
Ste 400
Neenah, WI 54956
Phone (414) 725-4527

Interoperability endpoints

  • Direct secure messaging: rbly442250@direct.hfhs.org

Organizations & group practices 1

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 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1367539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531440000000",
    "number": "1295170231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 THEDA CLARK MEDICAL PLZ",
            "address_2": "STE 400",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549562763",
            "telephone_number": "920-725-4527",
            "fax_number": "920-729-2378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 OAKLAND DR",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490081282",
            "telephone_number": "269-337-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLY",
        "first_name": "RYAN",
        "middle_name": "TIMOTHY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-03",
        "last_updated": "2018-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WI",
            "license": "69044",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

Verify at the official NPI Registry.