Individual provider Active NPI

Ryan Scott Innes, PA-C

  • Physician Assistant
  • East Setauket, NY
National Provider Identifier
1750193124
Registry record updated Jul 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
033630 Issued in NY
Practice address
6 Technology Dr Ste 100
East Setauket, NY 11733-4079
Phone
(631) 689-6698
Fax
(631) 751-5548
NPI assigned
Jan 23, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 033630 NY Primary

Addresses

Primary practice location

6 Technology Dr Ste 100
East Setauket, NY 11733-4079

Mailing address

6 Technology Dr Ste 100
East Setauket, NY 11733-4079
Phone (631) 689-6698

Other practice location 1

45 Whalen St
North Babylon, NY 11703-4421
Phone (631) 482-0504

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20250827002197 NY Practitioner - Physician Assistant 1052812633 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

200 Belle Terre Rd
Port Jefferson, NY 11777-1928
Phone (631) 689-6698

285 Sills Rd
BLDG 5 6
East Patchogue, NY 11772-4869
Phone (631) 475-2858

55 Medford Ave
Unit E
Patchogue, NY 11772-1229
Phone (631) 689-6698

6 Technology Dr
Suite 100
East Setauket, NY 11733-4079
Phone (631) 689-6698

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
033630NYMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopedic Assoc of Long Island Physicians & Medical Group PLLC CurrentSince Mar 26, 2025 Accepting new patients
Orthopedic Assoc of Long Island Physicians & Medical Group PLLC Orthopaedic Surgery CurrentSince Mar 26, 2025 Accepting new patients

Locations

6 Technology Dr
Ste 100
East Setauket, NY 11733
Phone (631) 371-2685

Interoperability endpoints

  • Direct secure messaging: rinnes@oali.emadirect.md

Organizations & group practices 2

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 2

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": "1737590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752796800000",
    "number": "1750193124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 TECHNOLOGY DR STE 100",
            "city": "EAST SETAUKET",
            "state": "NY",
            "postal_code": "117334079",
            "telephone_number": "631-689-6698",
            "fax_number": "631-751-5548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 TECHNOLOGY DR STE 100",
            "city": "EAST SETAUKET",
            "state": "NY",
            "postal_code": "117334079",
            "telephone_number": "631-689-6698",
            "fax_number": "631-751-5548"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "45 Whalen St",
            "address_purpose": "LOCATION",
            "city": "North Babylon",
            "state": "NY",
            "postal_code": "117034421",
            "country_code": "US",
            "telephone_number": "631-482-0504",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "INNES",
        "first_name": "RYAN",
        "middle_name": "SCOTT",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-01-23",
        "last_updated": "2025-07-18",
        "certification_date": "2025-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "033630",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Setauket, NY

Sources for this page

Verify at the official NPI Registry.