Individual provider Active NPI

Micah J Ryan, MD

  • Pediatrics Physician
  • Boys Town, NE
National Provider Identifier
1720373699
Registry record updated Jul 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
27825 Issued in NE
Practice address
14080 Boys Town Hospital Rd
Boys Town, NE 68010-7513
Phone
(402) 778-6900
Fax
(402) 778-6917
NPI assigned
Jun 18, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 27825 NE Primary
Pediatrics Physician 208000000X 6547 NE

Addresses

Primary practice location

14080 Boys Town Hospital Rd
Boys Town, NE 68010-7513

Mailing address

555 N 30TH St
Omaha, NE 68131-2136
Phone (402) 280-8100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE
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
I20140604001449 NE Practitioner - Pediatric Medicine 2264656669 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
6547NEMDPediatric Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Father Flanagan's Boys' Home Pediatrics CurrentSince Jul 15, 2014 Accepting new patients
ENT Services PC Past Accepting new patients
Nebraska Methodist Hospital Past Accepting new patients
Father Flanagan's Boys Home Past Accepting new patients

Locations

14092 Boys Town Hospital Rd
Boys Town, NE 68010
Phone (531) 355-1449

14080 Boys Town Hospital Rd
Boys Town, NE 68010
Phone (402) 778-6900

7205 W Center Rd
Ste 103
Omaha, NE 68124
Phone (402) 392-7600

6715 S 180th St
Omaha, NE 68135
Phone (531) 355-2300

555 N 30th St
Omaha, NE 68131
Phone (402) 280-8100

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1308355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405900800000",
    "number": "1720373699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 N 30TH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681312136",
            "telephone_number": "402-280-8100",
            "fax_number": "402-280-8103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14080 BOYS TOWN HOSPITAL RD",
            "city": "BOYS TOWN",
            "state": "NE",
            "postal_code": "680107513",
            "telephone_number": "402-778-6900",
            "fax_number": "402-778-6917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYAN",
        "first_name": "MICAH",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-18",
        "last_updated": "2014-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NE",
            "license": "27825",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NE",
            "license": "6547",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boys Town, NE

Sources for this page

Verify at the official NPI Registry.