Individual provider Active NPI

Ryan E Williams, DO

  • Family Medicine Physician
  • Sandy, OR
National Provider Identifier
1639344625
Registry record updated Sep 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DO154545 Issued in OR
Practice address
17055 Ruben LN
Sandy, OR 97055-9276
Phone
(503) 668-8002
Fax
(503) 668-5246
NPI assigned
Apr 29, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X DO154545 OR Primary

Addresses

Primary practice location

17055 Ruben LN
Sandy, OR 97055-9276

Mailing address

PO Box 92900
Portland, OR 97292-0900
Phone (503) 668-8002

Other names 1

  • Dr. Ryan E Ellis Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, WA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20111123000367 OR Practitioner - Family Practice 3173679032 Reassigns benefits to 1 organization
I20241203001877 WA Practitioner - Family Practice 3173679032 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Northwest Family Medicine CurrentSince Aug 1, 2016 Accepting new patients
Kaiser Foundation Health Plan of the Northwest CurrentSince Aug 1, 2016 Accepting new patients

Locations

10100 SE Sunnyside Rd
Clackamas, OR 97015
Phone (503) 571-2946

19500 SE Stark St
Portland, OR 97233
Phone (503) 669-3900

500 NE Multnomah St
Ste 100
Portland, OR 97232
Phone (503) 499-5200

2400 Lancaster Dr NE
Salem, OR 97305
Phone (503) 361-5400

1230 7th Ave
Longview, WA 98632
Phone (360) 575-4801

7101 NE 137th Ave
Vancouver, WA 98682
Phone (360) 418-6000

14406 NE 20th Ave
Vancouver, WA 98686
Phone (360) 418-6001

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.

NPI Registry JSON

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

{
    "created_epoch": "1209427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316736000000",
    "number": "1639344625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 92900",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972920900",
            "telephone_number": "503-668-8002",
            "fax_number": "503-668-5246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17055 RUBEN LN",
            "city": "SANDY",
            "state": "OR",
            "postal_code": "970559276",
            "telephone_number": "503-668-8002",
            "fax_number": "503-668-5246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "RYAN",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-29",
        "last_updated": "2011-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "DO154545",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RYAN",
            "last_name": "ELLIS",
            "middle_name": "E",
            "prefix": "DR.",
            "credential": "DO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Sandy, OR

Sources for this page

Verify at the official NPI Registry.