Individual provider Active NPI

Ryan Matthew Ricciardelli, MD

  • Anesthesiology Physician
  • Boston, MA
National Provider Identifier
1679150502
Registry record updated May 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
334745-01 Issued in NY
Practice address
330 Brookline Ave
Boston, MA 02215-5400
Phone
(617) 667-7000
NPI assigned
Mar 26, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 31, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 334745-01 NY Primary

Addresses

Primary practice location

330 Brookline Ave
Boston, MA 02215-5400

Mailing address

22 Gloria LN
Huntington, NY 11743-2227
Phone (631) 553-6930

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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 1

Enrollment IDStateProvider typePAC IDDetails
I20250416000407 NY Practitioner - Anesthesiology 8527583293 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Albany Medical College of Union University, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Shore - Lij Anesthesiology, PCGroup PAC ID 1153602453, 990 clinicians

Practice addresses (Care Compare)

1 Heroes Way
Riverhead, NY 11901-2054
Phone (631) 548-6000

Hospital & facility affiliations

  • North Shore University Hospital Hospital, Manhasset, NY, CCN 330106

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
334745-01NYMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Shore - Lij Anesthesiology, PC Anesthesiology CurrentSince Mar 18, 2025 Accepting new patients

Locations

10201 66th Rd
Forest Hills, NY 11375
Phone (718) 830-4091

195 E Main St
Huntington, NY 11743
Phone (631) 385-8677

1111 Marcus Ave
Ste M04
New Hyde Park, NY 11042
Phone (585) 736-3650

1 Heroes Way
Riverhead, NY 11901
Phone (631) 548-6000

Networks

  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H3359

Organizations & group practices 1

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.

Hospital & facility affiliations 1

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": "1616716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748649600000",
    "number": "1679150502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 GLORIA LN",
            "city": "HUNTINGTON",
            "state": "NY",
            "postal_code": "117432227",
            "telephone_number": "631-553-6930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 BROOKLINE AVE",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022155400",
            "telephone_number": "617-667-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICCIARDELLI",
        "first_name": "RYAN",
        "middle_name": "MATTHEW",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-26",
        "last_updated": "2025-05-31",
        "certification_date": "2025-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NY",
            "license": "334745-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boston, MA

Sources for this page

Verify at the official NPI Registry.