NPIMap

Individual provider Active NPI

Ryan Radwin Clark, PA-C

  • Physician Assistant
  • Black Mountain, NC
National Provider Identifier
1376283218
Registry record updated Mar 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
181 Lake Eden Rd
Black Mountain, NC 28711-8707
Phone
(704) 770-5527
NPI assigned
Mar 30, 2022
Last updated
Mar 30, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2022

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 Primary
Surgical Physician Assistant 363AS0400X

Addresses

Primary practice location

181 Lake Eden Rd
Black Mountain, NC 28711-8707

Mailing address

181 Lake Eden Rd
Black Mountain, NC 28711-8707
Phone (704) 770-5527

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20221111002133 NC Practitioner - Physician Assistant 6507233020 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Firsthealth of the Carolinas IncGroup PAC ID 8820909377, 138 clinicians

Practice addresses (Care Compare)

10 Aviemore Dr
Pinehurst, NC 28374-9700
Phone (910) 715-8700

155 Memorial Dr
Pinehurst, NC 28374-8710
Phone (910) 715-3500

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.75 of 100Reported as group
Quality
77.19
Promoting interoperability
86
Improvement activities
40
Cost
80.74

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Firsthealth of the Carolinas Inc CurrentSince May 7, 2022 Accepting new patients
Firsthealth of the Carolinas, Inc Dba Firsthealth Weight Management Clinic CurrentSince May 7, 2022 Accepting new patients

Locations

10 Aviemore Dr
Pinehurst, NC 28374
Phone (910) 215-5555

Interoperability endpoints

  • FHIR API: https://epicrp.firsthealth.org/FHIR-PRD/FHMYCHART/api/FHIR/R4

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 19

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1648598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648598400000",
    "number": "1376283218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "181 LAKE EDEN RD",
            "city": "BLACK MOUNTAIN",
            "state": "NC",
            "postal_code": "287118707",
            "telephone_number": "704-770-5527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "181 LAKE EDEN RD",
            "city": "BLACK MOUNTAIN",
            "state": "NC",
            "postal_code": "287118707",
            "telephone_number": "704-770-5527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "RYAN",
        "middle_name": "RADWIN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-30",
        "last_updated": "2022-03-30",
        "certification_date": "2022-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Black Mountain, NC

Sources for this page

Verify at the official NPI Registry.