Active NPI
Ryan Gannon
- Family Medicine Physician
- Jenkintown, PA
National Provider Identifier
1376108423
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD476373
- Practice address
- 101 Old York Rd Ste 201
Jenkintown, PA 19046-3912 - Phone
- (215) 248-8145
- NPI assigned
- May 3, 2019
- Last updated
- Jun 26, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD476373 | PA | Primary |
Addresses
Primary practice location
101 Old York Rd Ste 201
Jenkintown, PA 19046-3912
Mailing address
8000 Germantown Ave Apt 2F
Philadelphia, PA 19118-3440
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210301000562 | PA | Order and Referring Only - Family Practice | 8628483518 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1556841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656201600000",
"number": "1376108423",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8000 GERMANTOWN AVE APT 2F",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191183440"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 OLD YORK RD STE 201",
"city": "JENKINTOWN",
"state": "PA",
"postal_code": "190463912",
"telephone_number": "215-248-8145"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GANNON",
"first_name": "RYAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-05-03",
"last_updated": "2022-06-26",
"certification_date": "2022-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "PA",
"license": "MD476373",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jenkintown, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.