NPIMap

Individual provider Active NPI

Keith T Ryan, MD

  • Internal Medicine Physician
  • Flagstaff, AZ
National Provider Identifier
1366416869
Registry record updated Mar 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
22530 Issued in AZ
Practice address
107 E Oak Ave
Suite 202
Flagstaff, AZ 86001-1818
Phone
(928) 213-8633
Fax
(928) 213-8634
NPI assigned
Feb 14, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 1, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 22530 AZ Primary

Addresses

Primary practice location

107 E Oak Ave
Suite 202
Flagstaff, AZ 86001-1818

Mailing address

107 E Oak Ave
Suite 202
Flagstaff, AZ 86001-1818
Phone (928) 213-8633

Other identifiers 1

IdentifierTypeStateIssuer
167339MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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
I20061025000131 AZ Practitioner - Internal MedicinePractitioner - Cardiovascular Disease (Cardiology) 2668479213 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Cardiovascular Disease (Cardiology)
Education
University of Missouri, Columbia School of Medicine, 1991
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Ryan Internal Medicine PCGroup PAC ID 4082613708, 5 clinicians

Practice addresses (Care Compare)

1350 N Rim Dr
Flagstaff, AZ 86001-3111

Hospital & facility affiliations

  • Angels Care Home Health of Arizona No 5 Home health agency, Flagstaff, AZ, CCN 037500
  • Nurses Network by Quality Home Health Care Home health agency, Prescott Valley, AZ, CCN 037154
  • Flagstaff Medical Center Hospital, Flagstaff, AZ, CCN 030023
  • Verde Valley Medical Center Hospital, Cottonwood, AZ, CCN 030007

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
22530AZMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ryan Internal Medicine PC Internal Medicine CurrentSince Sep 11, 2006 Accepting new patients
Northern Arizona Medical Specialists PLLC Internal Medicine Past Accepting new patients
Flagstaff Medical Center Past Accepting new patients

Locations

107 E Oak Ave
Ste 202
Flagstaff, AZ 86001
Phone (928) 213-8631

107 E Oak Ave
#202
Flagstaff, AZ 86001
Phone (928) 773-2560

1350 N Rim Dr
Flagstaff, AZ 86001
Phone (928) 213-5881

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CFIEAA

Organizations & group practices 3

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 8

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": "1139875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1298937600000",
    "number": "1366416869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 E OAK AVE",
            "address_2": "SUITE 202",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860011818",
            "telephone_number": "928-213-8633",
            "fax_number": "928-213-8634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 E OAK AVE",
            "address_2": "SUITE 202",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860011818",
            "telephone_number": "928-213-8633",
            "fax_number": "928-213-8634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYAN",
        "first_name": "KEITH",
        "middle_name": "T",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-14",
        "last_updated": "2011-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "22530",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "167339",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flagstaff, AZ

Sources for this page

Verify at the official NPI Registry.