Ryan Kenneth Averett, D.P.M.
Individual provider Active NPI Podiatrist · Coeur D Alene, ID
NPI 1629065610 · NPPES record last updated Apr 22, 2016
Key facts
- NPI
- 1629065610
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Podiatrist 213E00000X
- License
- P177 (ID)
- Practice address
- 2221 N Ironwood Center Dr
Coeur D Alene, ID 83814-2697 - Phone
- (208) 667-3585
- Fax
- (855) 864-8364
- NPI assigned
- Oct 4, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 7
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Podiatry
- Education
- Other, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
2221 Iron Wood Ctr N Dr
Coeur D Alene, ID 83814-2697
Phone (208) 667-3585
Hospital & facility affiliations
- Kootenai Health
Merit-based Incentive Payment System (MIPS)
- Final score
- 86.65 of 100
- Quality
- 89.26
- Promoting interoperability
- 69.9
- Improvement activities
- 40
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of tissue | 53 |
| Removal of skin lesions | 1-10 |
| Removal of nail tissue | 338 |
| Removal or shaving of skin growth | 157 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040929000645 | ID | Practitioner - Podiatry | 0042202228 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P177 | ID | MD | Podiatrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kootenai Health, Inc. | Current |
Accepting new patients | |
| Kootenai Health, Inc. | Current |
Accepting new patients | |
| Kootenai Health, Inc. | Current |
Accepting new patients | |
| Kootenai Health, Inc. | Podiatrist | Current | Accepting new patients |
| Family Foot Health Care PLC | Podiatrist | Past | Accepting new patients |
| Christopher Butler DPM PC | Past |
Accepting new patients |
Locations
1118 N 4th St
Coeur D Alene, ID 83814
Phone (208) 667-3585
2003 Kootenai Health Way
Coeur D Alene, ID 83814
Phone (208) 625-5085
1300 E Mullan Ave
Ste 700
Post Falls, ID 83854
Phone (208) 625-5564
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | P177 | ID | Yes |
Addresses
Primary practice location
2221 N Ironwood Center Dr
Coeur D Alene, ID 83814-2697
Mailing address
2221 N Ironwood Center Dr
Coeur D Alene, ID 83814-2697
Phone (208) 667-3585
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 806936200 | Medicaid | ID | |
| P2451 | Other | BLUE CROSS OF IDAHO | |
| 000010147409 | Other | ID | REGENCE BLUE SHIELD |
| 1351085 | Other | ID | MEDICARE |
Other providers in Coeur D Alene, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 22, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.