Individual provider Active NPI

Elyse Rose Ryan, PA

  • Physician Assistant
  • Bronx, NY
National Provider Identifier
1366103558
Registry record updated Jun 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
111 E 210TH St
Bronx, NY 10467-2401
Phone
(718) 920-5731
NPI assigned
Jan 10, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2025

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 7065 CT
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

111 E 210TH St
Bronx, NY 10467-2401

Mailing address

34 Maple St
Norwalk, CT 06850-3894
Phone (203) 852-2000

Other practice location 1

34 Maple St
Norwalk, CT 06850-3894
Phone (203) 852-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, CT2 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

Enrollment IDStateProvider typePAC IDDetails
I20220927001202 NY Practitioner - Physician Assistant 2365828449 Reassigns benefits to 1 organization
I20250923003142 CT Practitioner - Physician Assistant 2365828449 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
May accept Medicare assignment
Group practices
Montefiore Medical CenterGroup PAC ID 3779496021, 2,809 clinicians

Practice addresses (Care Compare)

111 E 210TH St
Bronx, NY 10467-2401
Phone (866) 633-8255

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
7065CTMDPhysical Therapist
027916NYMDPediatric Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center CurrentSince May 31, 2022 Accepting new patients
Norwalk Hospital Association CurrentSince Sep 8, 2025 Accepting new patients
Norwalk Hospital Association CurrentSince Sep 8, 2025 Accepting new patients
Montefiore Medical Center CurrentSince May 31, 2022 Accepting new patients

Locations

34 Maple St
Norwalk, CT 06850
Phone (203) 852-2000

520 West Ave
Norwalk, CT 06850
Phone (203) 852-2417

111 E 210th St
Bronx, NY 10467

Networks

  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989

Interoperability endpoints

  • Direct secure messaging: elhopper@montefioredirect.com

Organizations & group practices 4

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 4

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": "1641772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748995200000",
    "number": "1366103558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34 MAPLE ST",
            "city": "NORWALK",
            "state": "CT",
            "postal_code": "068503894",
            "telephone_number": "203-852-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E 210TH ST",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104672401",
            "telephone_number": "718-920-5731"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "34 Maple St",
            "address_purpose": "LOCATION",
            "city": "Norwalk",
            "state": "CT",
            "postal_code": "068503894",
            "country_code": "US",
            "telephone_number": "203-852-2000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RYAN",
        "first_name": "ELYSE",
        "middle_name": "ROSE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-10",
        "last_updated": "2025-06-04",
        "certification_date": "2025-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "7065",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.