NPIMap

Individual provider Active NPI

Ryan W Anderson, PA-C

  • Medical Physician Assistant
  • Charleston, WV
National Provider Identifier
1407847833
Registry record updated Dec 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
01148 Issued in WV
Practice address
3701 Maccorkle Ave SE
Charleston, WV 25304-1525
Phone
(304) 442-5151
Fax
(304) 442-7494
NPI assigned
Nov 3, 2005
Last updated
Dec 13, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 01148 WV Primary

Addresses

Primary practice location

3701 Maccorkle Ave SE
Charleston, WV 25304-1525

Mailing address

401 6TH Ave
Montgomery, WV 25136-2116
Phone (304) 442-5151

Other identifiers 2

IdentifierTypeStateIssuer
01148OtherWVSTATE LICENSE NUMBER
374OtherWVWV BD. OSTEO LICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ryan.anderson@marshall.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
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
I20051018000365 WV Practitioner - Physician Assistant 5890711022 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1249 15TH St
Suite 2000
Huntington, WV 25701-3662
Phone (304) 691-1000

1600 Medical Ctr Dr
Huntington, WV 25701-3655

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
01148WVMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University Physicians & Surgeons, Inc. CurrentSince Jul 10, 2017 Accepting new patients
University Physicians & Surgeons, Inc. CurrentSince Jul 10, 2017 Accepting new patients
New Century Emergency Physician of West Virginia Inc Past Accepting new patients
Cross Lanes Family Practice, Inc. (Lab) Past Accepting new patients
Cabell Huntington Hospital Inc Past Accepting new patients

Locations

1249 15th St
Ste 4093
Huntington, WV 25701
Phone (304) 691-8714

1600 Medical Center Dr
Ste 3500
Huntington, WV 25701
Phone (304) 691-1300

Organizations & group practices 6

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 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1130976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639353600000",
    "number": "1407847833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 6TH AVE",
            "city": "MONTGOMERY",
            "state": "WV",
            "postal_code": "251362116",
            "telephone_number": "304-442-5151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3701 MACCORKLE AVE SE",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041525",
            "telephone_number": "304-442-5151",
            "fax_number": "304-442-7494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "RYAN",
        "middle_name": "W",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-03",
        "last_updated": "2021-12-13",
        "certification_date": "2021-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WV",
            "license": "01148",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "01148",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WV BD. OSTEO LICENSE",
            "identifier": "374",
            "state": "WV"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ryan.anderson@marshall.cernerdirect.com",
            "affiliation": "N",
            "address_1": "300 Corporate Center Drive",
            "city": "Scott Depot",
            "state": "WV",
            "country_code": "US",
            "postal_code": "25560",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charleston, WV

Sources for this page

Verify at the official NPI Registry.