Mia Lauren Ryckman, PHYSICIAN ASSISTANT

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

7560 Issued in AZ

Practice address

875 S Dobson Rd
Chandler, AZ 85224-5710

Phone

(480) 899-9800

Fax

(480) 899-2994

NPI assigned

Nov 4, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southeast Valley Gastroenterology Consultants, P.C.Group PAC ID 9436142270, 32 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

95.75 of 100Reported as group

Promoting interoperability

95

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Southeast Valley Gastroenterology Consultants, P.C.

  • Gastroenterology Physician
  • Chandler, AZ
  • NPI 1104861905
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1572825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572825600000",
    "number": "1417591348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "875 S DOBSON RD",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852245710",
            "telephone_number": "480-899-9800",
            "fax_number": "480-899-2994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 S DOBSON RD",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852245710",
            "telephone_number": "480-899-9800",
            "fax_number": "480-899-2994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYCKMAN",
        "first_name": "MIA",
        "middle_name": "LAUREN",
        "name_prefix": "Ms.",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-04",
        "last_updated": "2019-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "7560",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Craig Ryan, CRNA
• Crisini Rae Ryan
• Erin Ryan, PMHNP-BC
• Kelly Ryan
• Jason Arthur Rycerz
• Ryken Inc
• Ryken-Med Inc
• Kelly Lynn Ryker, MA, BCBA, LBA
• Rylyn, Inc.
• Dorothy J Rzewnicki, PNP

• Physician Assistant in Chandler, AZ
• Providers in Chandler, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2019; 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.