Ryan T McCulloch, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA405 Issued in ID

Practice address

147 W Chubbuck Rd
Chubbuck, ID 83202-2314

Phone

(208) 238-7546

Fax

(208) 237-9643

NPI assigned

Aug 25, 2006

Last updated

Dec 20, 2010By 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 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in ID

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

Physician Assistant

Education

University of Nebraska College of Medicine, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Idaho Skin Institute LLCGroup PAC ID 0648658807, 9 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Portneuf Medical Center Hospital, Pocatello, ID, CCN 130028

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as individual

Quality

100

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Idaho Skin Institute LLC

  • Dermatology Physician
  • Chubbuck, ID
  • NPI 1184375867
  Medicare reassignment Care Compare group
• Bear Lake County Memorial Hospital

  dba Bear Lake Internal Medicine

  • Internal Medicine Physician
  • Montpelier, ID
  • NPI 1174741441
  NPD (past)
• Stoddard & Bingham Medical of Twin Falls PLLC

  dba Idaho Skin Institute of Twin Falls

  • Dermatology Physician
  • Twin Falls, ID
  • NPI 1114691813
  NPD (past)
• Stoddard & Bingham Medical PLLC

  dba Idaho Skin Institute

  • Dermatology Physician
  • Burley, ID
  • NPI 1457912107
  NPD (past)

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

• Pocatello Hospital LLC

  dba Portneuf Rehabilitation Center

  • Rehabilitation Hospital Unit
  • Pocatello, ID
  • NPI 1144262114
  Care Compare affiliation
• Pocatello Hospital LLC

  dba Portneuf Medical Center

  • General Acute Care Hospital
  • Pocatello, ID
  • NPI 1790751055
  Care Compare affiliation

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1292803200000",
    "number": "1720195530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "147 W CHUBBUCK RD",
            "city": "CHUBBUCK",
            "state": "ID",
            "postal_code": "832022314",
            "telephone_number": "208-238-7546",
            "fax_number": "208-237-9643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "147 W CHUBBUCK RD",
            "city": "CHUBBUCK",
            "state": "ID",
            "postal_code": "832022314",
            "telephone_number": "208-238-7546",
            "fax_number": "208-237-9643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLOCH",
        "first_name": "RYAN",
        "middle_name": "T",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-25",
        "last_updated": "2010-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA405",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PTAN",
            "identifier": "P00329828",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806497600",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diane Watson Martin, LCSW
• Sarah May, PARAPROFESSIONAL
• Lisa McBeth
• Ellie McBride, PARAPROFESSIONAL
• Adam McCain, PARAPROFESSIONAL
• David Jim McGregor, NP
• Jared L McKee, DPT
• Steve J McKee, LCSW
• William L McKee, LCPC
• Amy Louise McKinlay, PA-C

• Physician Assistant in Chubbuck, ID
• Providers in Chubbuck, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2010; 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.