Ryan Edward Elassal, PT

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

1-E-8553 Issued in OK

Practice address

7919 Mid America Blvd Ste 100
Oklahoma City, OK 73135-6611

Phone

(405) 736-0064

NPI assigned

Jan 16, 2020

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 OK

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Boomer 06 PLLCGroup PAC ID 3870924723, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Boomer 06, PLLC

  dba The Mobile Therapy Group

  • Physical Therapist
  • Oklahoma City, OK
  • NPI 1871126383
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1579132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727136000000",
    "number": "1417587676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16905 HALBROOKE CIR",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730126864",
            "telephone_number": "405-996-0660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7919 MID AMERICA BLVD STE 100",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731356611",
            "telephone_number": "405-736-0064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELASSAL",
        "first_name": "RYAN",
        "middle_name": "EDWARD",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-01-16",
        "last_updated": "2024-09-24",
        "certification_date": "2024-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OK",
            "license": "5329",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "OK",
            "license": "1-E-8553",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah El-Koubysi
• Elaine Demke LLC
• Donna Oline Elam
• K George Elassal, DDS
• Phillip Elassal, DDS
• Sivaranjani Elavarasan, DDS
• Amru Omar Elayan, PHARMD
• Lucy A Elbah
• Nora Manar Elbaz, PA-C
• Alexander Elder, RN

• Durable Medical Equipment & Medical Supplies in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Durable Medical Equipment & Medical Supplies in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.