Mary Ellen Ryan, NP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

042924-23-02 Issued in NH

Practice address

20 Wall St
Burlington, MA 01803-4758

Phone

(617) 774-0774

NPI assigned

Oct 31, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in NH, MA2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mary.ellen.ryan.1@28516.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/28516/brand/1/csg/1/fhir/r4

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.

• Amoskeag Health

  • Federally Qualified Health Center (FQHC)
  • Manchester, NH
  • NPI 1083617013
  Medicare reassignment NPD
• Atrius Health, Inc.

  • Internal Medicine Physician
  • Beverly, MA
  • NPI 1114265634
  NPD
• Atrius Health, Inc.

  • Internal Medicine Physician
  • Boston, MA
  • NPI 1871639914
  NPD
• Amoskeag Health

  • Federally Qualified Health Center (FQHC)
  • Manchester, NH
  • NPI 1225625643
  NPD

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

{
    "created_epoch": "1193788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706054400000",
    "number": "1679752208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13 TANSY AVE",
            "city": "STRATHAM",
            "state": "NH",
            "postal_code": "038852289",
            "telephone_number": "603-682-6260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 WALL ST",
            "city": "BURLINGTON",
            "state": "MA",
            "postal_code": "018034758",
            "telephone_number": "617-774-0774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYAN",
        "first_name": "MARY ELLEN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-31",
        "last_updated": "2024-01-24",
        "certification_date": "2024-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MA",
            "license": "RN178290",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NH",
            "license": "042924-23-02",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30340376",
            "state": "NH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "23YP02412NH01",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "281670099",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cindy Leigh Russo, O.D.
• Kathryn Russo
• Thomas P Russo, MD
• Janice A Ryan, PTA
• Kaitlyn Ryan, FNP-BC
• Afaf Saab Khaddaje, MS,RD
• Toufic Tony Saad, MD
• Ana Patricia Saade Lemus, MD
• Amanda Sadat, PMHNP-BC
• Mazin Sadik, DPM

• Pediatric Nurse Practitioner in Burlington, MA
• Providers in Burlington, MA by specialty
• Pediatric Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.