Ryan Pham, D.O

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

P1128 Issued in TX

Practice address

621 SW Johnson Ave
Suite C
Burleson, TX 76028-5833

Phone

(817) 766-7421

Fax

(817) 447-8100

NPI assigned

May 4, 2010

Last updated

Nov 28, 2017By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

University of North Texas HSC, College of Osteopathic Med, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Center for DermatologyGroup PAC ID 7214288489, 4 clinicians

Prestige Dermatology of MidlothianGroup PAC ID 3577984251, 3 clinicians

Prestige Dermatology of Alliance PLLCGroup PAC ID 4284930959, 4 clinicians

Whhwc LLCGroup PAC ID 6002152188, 2 clinicians

Prestige Dermatology PLLCGroup PAC ID 2365752813, 5 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

0 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

0

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

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

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.

• Prestige Dermatology of Alliance, PLLC

  • Dermatology Physician
  • Fort Worth, TX
  • NPI 1427415314
  Medicare reassignment Care Compare group NPD Authorized official
• Prestige Dermatology of Midlothian

  • Dermatology Physician
  • Midlothian, TX
  • NPI 1912549833
  Medicare reassignment Care Compare group NPD Authorized official
• Prestige Dermatology PLLC

  • Dermatology Physician
  • Burleson, TX
  • NPI 1962878843
  Medicare reassignment Care Compare group NPD Authorized official
• Whhwc LLC

  dba Wellworx Health Hormone and Wellness Clinic

  • Multi-Specialty Clinic/Center
  • Frisco, TX
  • NPI 1245744580
  Medicare reassignment Care Compare group NPD Authorized official
• Center for Dermatology

  • Dermatology Physician
  • Arlington, TX
  • NPI 1164919502
  Medicare reassignment Care Compare group Authorized official
• Derm on Demand, LLC

  dba Derm On Demand

  • Dermatology Physician
  • Carrollton, TX
  • NPI 1780234237
  Medicare reassignment NPD Authorized official
• Wellworx Dermatology PLLC

  • Dermatology Physician
  • Frisco, TX
  • NPI 1164244703
  Medicare reassignment NPD Authorized official
• Dermone Dermatology Associates of Texas PA

  • Dermatology Physician
  • Arlington, TX
  • NPI 1831521780
  NPD (past)

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

{
    "created_epoch": "1272931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1511827200000",
    "number": "1407173230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 SW JOHNSON AVE",
            "city": "BURLESON",
            "state": "TX",
            "postal_code": "760285833",
            "telephone_number": "817-766-7421",
            "fax_number": "817-447-8100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 SW JOHNSON AVE",
            "address_2": "SUITE C",
            "city": "BURLESON",
            "state": "TX",
            "postal_code": "760285833",
            "telephone_number": "817-766-7421",
            "fax_number": "817-447-8100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAM",
        "first_name": "RYAN",
        "credential": "D.O",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-05-04",
        "last_updated": "2017-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "TX",
            "license": "P1128",
            "primary": true
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "TX",
            "license": "P1128",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Petr, MD
• Sarah E Petry, PT, DPT, ATC, LAT
• Samantha Pettit, LPC
• Michael Brandon Pettke, DC
• Nancy Kim Pham, DDS
• Teena Pham
• Physio Group, PLLC
• Joanne Joycelyn Picton, NP
• Sherrie Marie Pierce, NP
• Angela Pineda, NP

• Dermatology Physician in Burleson, TX
• Providers in Burleson, TX by specialty
• Dermatology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2017; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.