Individual provider Active NPI

Patrice M. Ryan, PH.D.

  • Clinical Psychologist
  • Knoxville, TN
National Provider Identifier
1366470809
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
P 1936 Issued in TN
Practice address
3001 Connie Rd
Knoxville, TN 37909-2314
Phone
(865) 691-7371
Fax
(865) 691-7374
NPI assigned
Jun 30, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X P 1936 TN Primary

Addresses

Primary practice location

3001 Connie Rd
Knoxville, TN 37909-2314

Mailing address

3001 Connie Rd
Knoxville, TN 37909-2314
Phone (865) 691-7371

Other identifiers 3

IdentifierTypeStateIssuer
3007427OtherTNBLUE CROSS BLUE SHIELD TN
3686797MedicaidTN
94550820OtherTNUNITED BEHAVIORAL HEALTH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100617000825 MO Practitioner - Clinical Psychologist 7719017789 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St. Louis Behavioral Medicine Institute IncGroup PAC ID 3173428638, 67 clinicians

Practice addresses (Care Compare)

1129 Macklind Ave
Saint Louis, MO 63110-1440
Phone 3145340200415

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
P 1936TNMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
St. Louis Behavioral Medicine Institute Inc CurrentSince May 11, 2010 Accepting new patients
St. Louis Behavioral Medicine Institute Inc CurrentSince May 11, 2010 Accepting new patients

Locations

1129 Macklind Ave
Saint Louis, MO 63110
Phone (314) 534-0200

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1366470809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 CONNIE RD",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379092314",
            "telephone_number": "865-691-7371",
            "fax_number": "865-691-7374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 CONNIE RD",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379092314",
            "telephone_number": "865-691-7371",
            "fax_number": "865-691-7374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYAN",
        "first_name": "PATRICE",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TN",
            "license": "P 1936",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD TN",
            "identifier": "3007427",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3686797",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED BEHAVIORAL HEALTH",
            "identifier": "94550820",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

Verify at the official NPI Registry.