Individual provider Active NPI

Ryan Odiorne, PA-C

  • Surgical Physician Assistant
  • Las Vegas, NV
National Provider Identifier
1457121097
Registry record updated Jan 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA2922 Issued in NV
Practice address
2800 E Desert Inn Rd Ste 100
Las Vegas, NV 89121-3609
Phone
(702) 731-1616
NPI assigned
Jan 4, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA2922 NV Primary

Addresses

Primary practice location

2800 E Desert Inn Rd Ste 100
Las Vegas, NV 89121-3609

Mailing address

2800 E Desert Inn Rd Ste 100
Las Vegas, NV 89121-3609
Phone (702) 731-1616

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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

Enrollment IDStateProvider typePAC IDDetails
I20240402002185 NV Practitioner - Physician Assistant 2264870880 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Touro Un Col of Osteopathic Medicine, Henderson, 2020
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

2800 E Desert Inn Rd
Suite 100
Las Vegas, NV 89121-3609

PO Box
Suite 1084
Elizabeth City, NC 27906-1084

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA2922NVMDSurgical Physician Assistant

Interoperability endpoints

  • Direct secure messaging: odiry@doclv.emadirect.md

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1704326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704326400000",
    "number": "1457121097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 E DESERT INN RD STE 100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891213609",
            "telephone_number": "702-731-1616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2800 E DESERT INN RD STE 100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891213609",
            "telephone_number": "702-731-1616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODIORNE",
        "first_name": "RYAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-01-04",
        "last_updated": "2024-01-04",
        "certification_date": "2024-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NV",
            "license": "PA2922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.