NPIMap

Individual provider Active NPI

Rylan Chan, PAC

  • Physician Assistant
  • Meridian, ID
National Provider Identifier
1306874623
Registry record updated Jul 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA-1342 Issued in ID
Practice address
1623 S Wells Ave
Meridian, ID 83642-5040
Phone
(208) 489-1450
NPI assigned
Jun 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2557 AZ
Physician Assistant 363A00000X PA-1342 ID Primary

Addresses

Primary practice location

1623 S Wells Ave
Meridian, ID 83642-5040

Mailing address

PO Box 191050
Boise, ID 83719-1050
Phone (208) 955-6522

Other identifiers 1

IdentifierTypeStateIssuer
950552MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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
I20160304000868 ID Practitioner - Physician Assistant 0345273744 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Alliance Medical Group LLCGroup PAC ID 3971544685, 132 clinicians

Practice addresses (Care Compare)

10482 W Carlton Bay Dr
Garden City, ID 83714-5143
Phone (208) 955-6500

1375 N Happy Valley Rd
Nampa, ID 83687-5280
Phone (208) 809-2869

1474 N Meridian Rd
Kuna, ID 83634-2041
Phone (208) 809-2885

1475 N Cole Rd
Boise, ID 83704-8537
Phone (208) 809-2880

1623 S Wells Ave
Meridian, ID 83642-5040
Phone (208) 489-1450

1895 McGrath Rd
Eagle, ID 83616-6243
Phone (208) 939-8200

1900 W Chinden Blvd
Meridian, ID 83646-6690
Phone (208) 809-2860

260 S Ten Mile Rd
Meridian, ID 83642-6100
Phone (208) 809-2872

4971 W Overland Rd
Boise, ID 83705-2822
Phone (208) 472-5050

6052 W State St
Boise, ID 83703-2739
Phone (208) 947-1947

8971 W Overland Rd
Boise, ID 83709-1651
Phone (208) 378-4288

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2557AZMDPastoral Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Alliance Medical Group, LLC CurrentSince Mar 7, 2016 Accepting new patients
Alliance Medical Group, LLC CurrentSince Mar 7, 2016 Accepting new patients
Desert Ridge Urgent Care LLC Past Accepting new patients
Glendale Urgent Care LLC Past Accepting new patients
Alliance Medical Group, LLC Past Accepting new patients
Nextcare Arizona I JV LLC Past Accepting new patients
Dana Landing Urgent Care LLC Past Accepting new patients
Chandler Urgent Care LLC Past Accepting new patients
Sun City Urgent Care LLC Past Accepting new patients
Avondale Urgent Care LLC Past Accepting new patients
Cardiojost, PLLC Past Accepting new patients
Pinnacle Medicine Inc. Past Accepting new patients
Greenway Urgent Care LLC Past Accepting new patients
Shea Urgent Care LLC Past Accepting new patients

Locations

512 N 21st Ave
Caldwell, ID 83605
Phone (208) 809-2875

10482 W Carlton Bay Dr
Garden City, ID 83714
Phone (208) 454-9690

1623 S Wells Ave
Meridian, ID 83642
Phone (208) 489-1450

Interoperability endpoints

  • Direct secure messaging: rylan.chan@phmg.eclinicaldirectplus.com

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 10

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": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626739200000",
    "number": "1306874623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 191050",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837191050",
            "telephone_number": "208-955-6522",
            "fax_number": "208-955-6503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1623 S WELLS AVE",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836425040",
            "telephone_number": "208-489-1450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "RYLAN",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2021-07-20",
        "certification_date": "2021-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "2557",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA-1342",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "950552",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

Verify at the official NPI Registry.