NPIMap

Individual provider Active NPI

Kevin Michael Ryan, PA

  • Physician Assistant
  • Brockton, MA
National Provider Identifier
1548769524
Registry record updated Apr 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA7481 Issued in MA
Practice address
35 Pearl St Ste 200
Brockton, MA 02301-2866
Phone
(508) 588-8034
Fax
(508) 897-0475
NPI assigned
Feb 6, 2018
Last updated
Apr 18, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA7481 MA Primary
Surgical Physician Assistant 363AS0400X NU

Addresses

Primary practice location

35 Pearl St Ste 200
Brockton, MA 02301-2866

Mailing address

35 Pearl St Ste 100
Brockton, MA 02301-1195
Phone (781) 769-3222

Other practice location 1

41 Mall Rd
Burlington, MA 01805-2866
Phone (781) 744-8000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200519000548 MA Practitioner - Physician Assistant 1456614924 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lahey Clinic IncGroup PAC ID 2264336528, 1,381 clinicians

Practice addresses (Care Compare)

29 Mall Rd
Burlington, MA 01805-0001

41 Mall Rd
Burlington, MA 01805-0001

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lahey Clinic, Inc CurrentSince Jun 1, 2020 Accepting new patients
ENT Norwood LLC CurrentSince Nov 27, 2018 Accepting new patients

Locations

35 Pearl St
Ste 100
Brockton, MA 02301
Phone (508) 588-8034

35 Pearl St
Ste 200
Brockton, MA 02301
Phone (508) 588-8034

41 Mall Rd
Burlington, MA 01805
Phone (781) 744-8400

333 Elm St
Dedham, MA 02026
Phone (781) 214-6590

825 Washington St
Ste 310
Norwood, MA 02062
Phone (508) 880-3460

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HFADAA
  • Direct secure messaging: kryan147973@direct.bilh.masshiway.net

Organizations & group practices 4

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.

Hospital & facility affiliations 12

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": "1517875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681776000000",
    "number": "1548769524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 PEARL ST STE 100",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023011195",
            "telephone_number": "781-769-3222",
            "fax_number": "781-255-9807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 PEARL ST STE 200",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "023012866",
            "telephone_number": "508-588-8034",
            "fax_number": "508-897-0475"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "41 Mall Rd",
            "address_purpose": "LOCATION",
            "city": "Burlington",
            "state": "MA",
            "postal_code": "018052866",
            "country_code": "US",
            "telephone_number": "781-744-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RYAN",
        "first_name": "KEVIN",
        "middle_name": "MICHAEL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-02-06",
        "last_updated": "2023-04-18",
        "certification_date": "2023-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "PA7481",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brockton, MA

Sources for this page

Verify at the official NPI Registry.