Individual provider Active NPI

Ryan Allen Baker, M.D.

  • Pediatrics Physician
  • Lutz, FL
National Provider Identifier
1457778383
Registry record updated Jul 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME144985 Issued in FL
Practice address
1854 Oak Grove Blvd
Lutz, FL 33559-8605
Phone
(813) 948-6133
Fax
(813) 948-3460
NPI assigned
Mar 28, 2014
Last updated
Jul 8, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 40493 SC
Pediatrics Physician 208000000X ME144985 FL Primary

Addresses

Primary practice location

1854 Oak Grove Blvd
Lutz, FL 33559-8605

Mailing address

4033 Tampa Rd Ste 101
Oldsmar, FL 34677-3224
Phone (813) 854-2003

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20170804000622 SC Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 8628296761

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME144985FLMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pediatric Health Care Alliance, PA Pediatrics CurrentSince Aug 28, 2021 Accepting new patients
Pediatric Health Care Alliance, PA Pediatrics Past Accepting new patients

Locations

1854 Oak Grove Blvd
Lutz, FL 33559
Phone (813) 471-9709

4033 Tampa Rd
Ste 101
Oldsmar, FL 34677
Phone (813) 854-2003

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1395964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594166400000",
    "number": "1457778383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4033 TAMPA RD STE 101",
            "city": "OLDSMAR",
            "state": "FL",
            "postal_code": "346773224",
            "telephone_number": "813-854-2003",
            "fax_number": "813-436-5378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1854 OAK GROVE BLVD",
            "city": "LUTZ",
            "state": "FL",
            "postal_code": "335598605",
            "telephone_number": "813-948-6133",
            "fax_number": "813-948-3460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAKER",
        "first_name": "RYAN",
        "middle_name": "ALLEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-28",
        "last_updated": "2020-07-08",
        "certification_date": "2020-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "40493",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME144985",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lutz, FL

Sources for this page

Verify at the official NPI Registry.