Active NPI
Jimmy Lynn Ryan, M.D.
- Pediatrics Physician
- Riverton, UT
National Provider Identifier
1508800145
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 172229-1205
- Practice address
- 1288 W 12700 S
Riverton, UT 84065-6794 - Phone
- (801) 253-3500
- Fax
- (801) 253-5859
- NPI assigned
- Jun 15, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 172229-1205 | UT | Primary |
Addresses
Primary practice location
1288 W 12700 S
Riverton, UT 84065-6794
Mailing address
PO Box 1010
Riverton, UT 84065-1010
Phone (801) 253-3500
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| QM0000032877 | Other | UT | ALTIUS HEALTH PLANS |
| 870641072RY1 | Other | UT | EDUCATORS MUTUAL |
| PR00710 | Other | UT | MOLINA HEALTHCARE |
| 071262 | Other | UT | SELECT HEALTH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 172229-1205 | UT | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424822400000",
"number": "1508800145",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1010",
"city": "RIVERTON",
"state": "UT",
"postal_code": "840651010",
"telephone_number": "801-253-3500",
"fax_number": "801-253-5859"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1288 W 12700 S",
"city": "RIVERTON",
"state": "UT",
"postal_code": "840656794",
"telephone_number": "801-253-3500",
"fax_number": "801-253-5859"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RYAN",
"first_name": "JIMMY",
"middle_name": "LYNN",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-15",
"last_updated": "2015-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "UT",
"license": "172229-1205",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ALTIUS HEALTH PLANS",
"identifier": "QM0000032877",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EDUCATORS MUTUAL",
"identifier": "870641072RY1",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MOLINA HEALTHCARE",
"identifier": "PR00710",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SELECT HEALTH",
"identifier": "071262",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Riverton, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.