NPIMap

Individual provider Active NPI

Ryan Stewart Clark, D.O.

  • Cardiovascular Disease Physician
  • Kettering, OH
National Provider Identifier
1396049011
Registry record updated Jan 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
34010728 Issued in OH
Practice address
1380 E Stroop Rd
Kettering, OH 45429-4926
Phone
(937) 293-3486
Fax
(937) 293-3605
NPI assigned
Jan 10, 2011
Last updated
Jan 28, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 28, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 58.003689 OH
Internal Medicine Physician 207R00000X 34010728 OH
Cardiovascular Disease Physician 207RC0000X 34010728 OH Primary

Addresses

Primary practice location

1380 E Stroop Rd
Kettering, OH 45429-4926

Mailing address

1103 Fairington Dr
Sidney, OH 45365-8130
Phone (937) 980-7400

Other identifiers 1

IdentifierTypeStateIssuer
0100097MedicaidOH

Electronic endpoints 2

TypeEndpointUseAffiliation
FHIR URL https://khnarr.ketthealth.com/FHIR-PROD/api/FHIR/DSTU2/
Direct Messaging Address rclark441756@direct.ketteringhealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20131015000780 OH Practitioner - Internal MedicinePractitioner - Cardiovascular Disease (Cardiology) 4183862105 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Cardiovascular Disease (Cardiology)
Education
Nova Southeastern Univ College of Dental Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kettering Independent Medical Group IncGroup PAC ID 3173710936, 699 clinicians

Practice addresses (Care Compare)

600 W Main St
Suite 330
Troy, OH 45373-3384
Phone (937) 458-0085

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.34 of 100Reported as group
Quality
63.67
Promoting interoperability
100
Improvement activities
40
Cost
74.14

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34010728OHMDInternal Medicine Physician
58.003689OHMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Lima Memorial Joint Operating Company Past Accepting new patients

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

Hospital & facility affiliations 5

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": "1294617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611792000000",
    "number": "1396049011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1103 FAIRINGTON DR",
            "city": "SIDNEY",
            "state": "OH",
            "postal_code": "453658130",
            "telephone_number": "937-980-7400",
            "fax_number": "937-980-7441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1380 E STROOP RD",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454294926",
            "telephone_number": "937-293-3486",
            "fax_number": "937-293-3605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "RYAN",
        "middle_name": "STEWART",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-01-10",
        "last_updated": "2021-01-28",
        "certification_date": "2021-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OH",
            "license": "58.003689",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "34010728",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "OH",
            "license": "34010728",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0100097",
            "state": "OH"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://khnarr.ketthealth.com/FHIR-PROD/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "1103 Fairington Dr",
            "city": "Sidney",
            "state": "OH",
            "country_code": "US",
            "postal_code": "453658130",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rclark441756@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "1103 Fairington Dr",
            "city": "Sidney",
            "state": "OH",
            "country_code": "US",
            "postal_code": "453658130",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kettering, OH

Sources for this page

Verify at the official NPI Registry.