Individual provider Active NPI

Ryan Skoog

  • Physician Assistant
  • Staples, MN
National Provider Identifier
1689346967
Registry record updated Oct 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
13765 Issued in MN
Practice address
49725 County 83
Staples, MN 56479-5280
Phone
(218) 894-1515
NPI assigned
Oct 4, 2021
Last updated
Oct 4, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 13765 MN Primary
Surgical Physician Assistant 363AS0400X 13765 MN

Addresses

Primary practice location

49725 County 83
Staples, MN 56479-5280

Mailing address

242 W Johnson St
Menahga, MN 56464-2296
Phone (218) 849-7288

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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

Enrollment IDStateProvider typePAC IDDetails
I20211026002468 MN Practitioner - Physician Assistant 4880082783 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Infinite Health Collaborative, PAGroup PAC ID 1052225042, 815 clinicians
Lakewood Health SystemGroup PAC ID 1052229671, 107 clinicians

Practice addresses (Care Compare)

16800 37TH PL N
Plymouth, MN 55446-2805
Phone (763) 520-7870

3111 124TH Ave NW
Suite 200
Coon Rapids, MN 55433-4573
Phone (763) 427-7300

3545 Hwy 61 N
Vadnais Heights, MN 55110-5223
Phone (651) 439-8807

49725 County
Suite 83
Staples, MN 56479-5280
Phone (218) 894-1515

5715 Memorial Ave N
Oak Park Heights, MN 55082-1093
Phone (651) 439-8807

820 Village Way
Waconia, MN 55387-4612

965 Prairie Ctr Dr
Eden Prairie, MN 55344-3671

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
13765MNMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Infinite Health Collaborative, PA CurrentSince Dec 20, 2024 Accepting new patients
Lakewood Health System CurrentSince Oct 18, 2021 Accepting new patients
Infinite Health Collaborative, PA CurrentSince Dec 20, 2024 Accepting new patients

Locations

3500 American Blvd W
Ste 300
Minneapolis, MN 55431
Phone (952) 512-5600

920 E 28th St
Ste 440
Minneapolis, MN 55407
Phone (612) 863-5155

49725 County 83
Staples, MN 56479
Phone (218) 894-1033

Interoperability endpoints

  • Direct secure messaging: rskoog625750@direct.ochin.org

Organizations & group practices 4

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.

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": "1633305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633305600000",
    "number": "1689346967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "242 W JOHNSON ST",
            "city": "MENAHGA",
            "state": "MN",
            "postal_code": "564642296",
            "telephone_number": "218-849-7288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49725 COUNTY 83",
            "city": "STAPLES",
            "state": "MN",
            "postal_code": "564795280",
            "telephone_number": "218-894-1515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SKOOG",
        "first_name": "RYAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-04",
        "last_updated": "2021-10-04",
        "certification_date": "2021-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "13765",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MN",
            "license": "13765",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staples, MN

Sources for this page

Verify at the official NPI Registry.