Individual provider Active NPI

Sandra Lynn Ryan, RN

  • Family Nurse Practitioner
  • San Antonio, TX
National Provider Identifier
1558903583
Registry record updated May 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
1045869 Issued in TX
Practice address
1715 McCullough Ave
San Antonio, TX 78212-4046
Phone
(210) 225-5323
Fax
(210) 225-7505
NPI assigned
Oct 10, 2019
Last updated
May 16, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 1045869 TX Primary

Addresses

Primary practice location

1715 McCullough Ave
San Antonio, TX 78212-4046

Mailing address

1715 McCullough Ave
San Antonio, TX 78212-4046
Phone (210) 225-5323

Other identifiers 1

IdentifierTypeStateIssuer
427467201MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20210716000343 TX Practitioner - Nurse Practitioner 4486056280 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellmed Medical Group PAGroup PAC ID 4880657386, 666 clinicians

Practice addresses (Care Compare)

6157 NW Loop 410
124 Wellmed at Ingram Park
San Antonio, TX 78238-3302
Phone (210) 523-1411

7959 Fredericksburg Rd
Suite 105
San Antonio, TX 78229-3431
Phone (726) 268-7439

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
1045869TXMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Centerwell Senior Primary Care (SC) PC CurrentSince Mar 16, 2026 Accepting new patients
Wellmed Medical Group, PA CurrentSince Jul 19, 2021 Accepting new patients
Wellmed Medical Group, P.a. CurrentSince Jul 19, 2021 Accepting new patients
Conviva Medical Center Management of Texas, P.a. CurrentSince Mar 16, 2026 Accepting new patients

Locations

14100 Nacogdoches Rd
Ste 116
San Antonio, TX 78247
Phone (210) 491-8136

1715 McCullough Ave
San Antonio, TX 78212
Phone (210) 225-5323

517 SW Military Dr
Ste A
San Antonio, TX 78221
Phone (210) 558-0121

6157 NW Loop 410
Ste 124
San Antonio, TX 78238
Phone (210) 523-1411

7031 Marbach Rd
San Antonio, TX 78227
Phone (210) 761-3363

7959 Fredericksburg Rd
Ste 105
San Antonio, TX 78229
Phone (726) 268-7439

8637 Fredericksburg Rd
Ste 360
San Antonio, TX 78240
Phone (210) 304-3500

Interoperability endpoints

  • Direct secure messaging: sandra.ryan@wellmed.eclinicaldirectplus.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1570665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652659200000",
    "number": "1558903583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1715 MCCULLOUGH AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782124046",
            "telephone_number": "210-225-5323",
            "fax_number": "210-225-7505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1715 MCCULLOUGH AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782124046",
            "telephone_number": "210-225-5323",
            "fax_number": "210-225-7505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYAN",
        "first_name": "SANDRA",
        "middle_name": "LYNN",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-10",
        "last_updated": "2022-05-16",
        "certification_date": "2022-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1045869",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "427467201",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.