Individual provider Active NPI

Ryan Rogers, PA-C

  • Physician Assistant
  • Statesboro, GA
National Provider Identifier
1740929306
Registry record updated Jun 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
11904 Issued in GA
Practice address
17007 Highway 67
Statesboro, GA 30458-2426
Phone
(912) 681-2500
Fax
(912) 681-2025
NPI assigned
Jun 1, 2022
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 30, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 11904 GA
Physician Assistant 363A00000X 11904 GA Primary

Addresses

Primary practice location

17007 Highway 67
Statesboro, GA 30458-2426

Mailing address

210 E Derenne Ave
Savannah, GA 31405-6736
Phone (912) 644-5300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20231130001344 GA Practitioner - Physician Assistant 2466800578 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Philadelphia Col of Osteo Med, Sewanee, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Optim Orthopedics LLCGroup PAC ID 9931427002, 101 clinicians
Tattnall Hospital Company LLCGroup PAC ID 6204907124, 47 clinicians

Practice addresses (Care Compare)

101 W Mulberry Blvd
Suite 140
Savannah, GA 31407-3507
Phone (912) 748-5111

119 B Victory Dr
Swainsboro, GA 30401-3234
Phone (478) 289-3198

17007 Hwy 67
Statesboro, GA 30458-2426
Phone (912) 681-2500

210 E Derenne Ave
Savannah, GA 31405-6736
Phone (912) 644-5300

602 E Long St
Claxton, GA 30417-5914
Phone (912) 739-3275

790 Veterans Pkwy
Suite 111
Hinesville, GA 31313-3991
Phone (912) 877-4400

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11904GAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Optim Orthopedics, LLC Multi-Specialty CurrentSince Jun 18, 2025 Accepting new patients
Tattnall Hospital Company, LLC Multi-Specialty CurrentSince Sep 1, 2025 Accepting new patients
Optim Orthopedics, LLC Multi-Specialty CurrentSince Jun 18, 2025 Accepting new patients
Tattnall Hospital Company, LLC Multi-Specialty CurrentSince Sep 1, 2025 Accepting new patients
Optim Orthopedics, LLC Multi-Specialty Past Accepting new patients
Optim Orthopedics, LLC Multi-Specialty PastSince Oct 6, 2019 Accepting new patients

Locations

247 S Main St
#A
Reidsville, GA 30453
Phone (912) 352-4490

210 E Derenne Ave
Savannah, GA 31405
Phone (912) 355-0140

Interoperability endpoints

  • Direct secure messaging: ryan.rogers.2@16403.direct.athenahealth.com
  • Direct secure messaging: ryan.rogers.1@16403.direct.athenahealth.com

Organizations & group practices 8

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 3

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": "1654041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751241600000",
    "number": "1740929306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 E DERENNE AVE",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314056736",
            "telephone_number": "912-644-5300",
            "fax_number": "912-644-5241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17007 HIGHWAY 67",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304582426",
            "telephone_number": "912-681-2500",
            "fax_number": "912-681-2025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROGERS",
        "first_name": "RYAN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-06-01",
        "last_updated": "2025-06-30",
        "certification_date": "2025-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "11904",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "11904",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Statesboro, GA

Sources for this page

Verify at the official NPI Registry.