Individual provider Active NPI

Ryan Dougherty, PA-C

  • Surgical Physician Assistant
  • Wilmington, NC
National Provider Identifier
1467173443
Registry record updated Sep 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
0010-1249 Issued in NC
Practice address
3787 Shipyard Blvd
Wilmington, NC 28403-6148
Phone
(910) 909-4163
NPI assigned
Sep 7, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2022

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 0010-1249 NC Primary

Addresses

Primary practice location

3787 Shipyard Blvd
Wilmington, NC 28403-6148

Mailing address

311 Arboretum Dr
Wilmington, NC 28405-6252

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20221031002505 NC Practitioner - Physician Assistant 4385011550 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergeortho PAGroup PAC ID 0749188894, 726 clinicians

Practice addresses (Care Compare)

3787 Shipyard Blvd
Wilmington, NC 28403-6148
Phone (910) 332-3800

5160 Ocean Hwy W
Shallotte, NC 28470-4012
Phone (910) 332-3800

799 Doctors CT
Roxboro, NC 27573-4571
Phone (336) 599-4079

8115 Market St
Suite 108
Wilmington, NC 28411-8429
Phone (910) 332-3800

Hospital & facility affiliations

  • Novant Health New Hanover Regional Medical Center Hospital, Wilmington, NC, CCN 340141

Merit-based Incentive Payment System (MIPS)

Final score
89.07 of 100Reported as group
Quality
85.94
Promoting interoperability
100
Improvement activities
40
Cost
77.63

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0010-1249NCMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Emergeortho PA CurrentSince Sep 12, 2022 Accepting new patients
Emergeortho PA CurrentSince Sep 12, 2022 Accepting new patients

Locations

799 Doctors Ct
Roxboro, NC 27573
Phone (336) 599-4079

3787 Shipyard Blvd
Wilmington, NC 28403
Phone (910) 341-2444

Interoperability endpoints

  • Direct secure messaging: ryan.dougherty.1@847.direct.athenahealth.com
  • Direct secure messaging: rdougherty1245342@direct.novanthealth.org

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1662508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662508800000",
    "number": "1467173443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 ARBORETUM DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284056252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3787 SHIPYARD BLVD",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284036148",
            "telephone_number": "910-909-4163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGHERTY",
        "first_name": "RYAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-09-07",
        "last_updated": "2022-09-07",
        "certification_date": "2022-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NC",
            "license": "0010-1249",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.