Mark Kenneth Ryan, CRNP MSN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

LG-0000752 Issued in DE

Practice address

30549 Sussex Hwy
Laurel, DE 19956-3891

Phone

(302) 715-5214

Fax

(302) 628-6855

NPI assigned

Feb 22, 2006

Last updated

Feb 29, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in DE

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

Specialty

Nurse Practitioner

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tidalhealth Physician Network, Inc.Group PAC ID 7315901253, 115 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Tidalhealth Nanticoke, Inc. Hospital, Seaford, DE, CCN 080006

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Tidalhealth Physician Network, Inc.

  • Family Medicine Physician
  • Seaford, DE
  • NPI 1467534636
  Medicare reassignment Care Compare group NPD
• Frederick Health Hospital Inc

  dba Frederick Health Hospital

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Tidalhealth Nanticoke, Inc

  • General Acute Care Hospital
  • Seaford, DE
  • NPI 1245214477
  Care Compare affiliation

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

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456704000000",
    "number": "1669447637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30549 SUSSEX HWY",
            "city": "LAUREL",
            "state": "DE",
            "postal_code": "199563891",
            "telephone_number": "302-715-5214",
            "fax_number": "302-628-6855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30549 SUSSEX HWY",
            "city": "LAUREL",
            "state": "DE",
            "postal_code": "199563891",
            "telephone_number": "302-715-5214",
            "fax_number": "302-628-6855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYAN",
        "first_name": "MARK",
        "middle_name": "KENNETH",
        "name_prefix": "Mr.",
        "credential": "CRNP MSN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-22",
        "last_updated": "2016-02-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MD",
            "license": "AC000091",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "AC000091",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "DE",
            "license": "LG-0000752",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "403638700",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Psychological Associates of Southern Delaware
• Jaden Sierra Raynor
• Richard J. Tananis, D.D.S., L.L.C.
• Rite Aid of Delaware Inc (Rite Aid Pharmacy 04914)
• Lauren Emilee Ruf
• Mohammed Hassan Saleh
• Kristen Schaffer, MSO, NCC
• Amanda Schuler, LCSW
• Scooters-4-Rent ,LLC
• Melanie Shepherd, MA, M.ED

• Family Nurse Practitioner in Laurel, DE
• Providers in Laurel, DE by specialty
• Family Nurse Practitioner in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.