Individual provider Active NPI

Ryan D Williams, PA-C

  • Physician Assistant
  • Moses Lake, WA
National Provider Identifier
1770818361
Registry record updated Oct 15, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
605 S Coolidge St
Moses Lake, WA 98837-1893
Phone
(509) 765-0674
Fax
(509) 766-8993
NPI assigned
Oct 15, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2009

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 Primary

Addresses

Primary practice location

605 S Coolidge St
Moses Lake, WA 98837-1893

Mailing address

1208 W Franklin St # a
Moses Lake, WA 98837-1342
Phone (208) 521-4259

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20130905000807 ID Practitioner - Physician Assistant 0648311662 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mountain View Hospital LLCGroup PAC ID 4486562774, 272 clinicians

Practice addresses (Care Compare)

2305 Coronado St
Idaho Falls, ID 83404-7407
Phone (208) 522-1764

2325 Coronado St
Idaho Falls, ID 83404-7407
Phone (208) 557-2700

2330 Coronado St
Idaho Falls, ID 83404-7407
Phone (208) 552-1234

2351 Coronado St
Idaho Falls, ID 83404-7407
Phone (208) 522-7310

2353 Coronado St
Idaho Falls, ID 83404-7407
Phone (208) 552-4823

2375 Coronado St
Idaho Falls, ID 83404-7407
Phone (208) 552-1234

3385 Potomac Way
Idaho Falls, ID 83404-4978
Phone (208) 522-7246

Hospital & facility affiliations

  • Mountain View Hospital Hospital, Idaho Falls, ID, CCN 130065
  • Eastern Idaho Regional Medical Center Hospital, Idaho Falls, ID, CCN 130018

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
M-10968IDMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain View Hospital LLC CurrentSince Aug 19, 2015 Accepting new patients
Community Care PLLC Past Accepting new patients
Mountain View Hospital Physician Organization Past Accepting new patients
Moses Lake Community Health Center Past Accepting new patients
Moses Lake Community Health Center Past Accepting new patients

Locations

1425 Parkway Dr
Blackfoot, ID 83221
Phone (208) 785-2600

2325 Coronado St
Idaho Falls, ID 83404
Phone (208) 528-7686

2250 Coronado St
Ste A
Idaho Falls, ID 83404
Phone (208) 542-4140

3425 Potomac Way
Idaho Falls, ID 83404
Phone (208) 528-8170

2375 E Sunnyside Rd
Ste J
Idaho Falls, ID 83404
Phone (208) 522-7246

3385 Potomac Way
Idaho Falls, ID 83404
Phone (208) 522-7246

150 Vista Dr
Pocatello, ID 83201
Phone (208) 232-2146

Organizations & group practices 5

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": "1255564800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1255564800000",
    "number": "1770818361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1208 W FRANKLIN ST # A",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "988371342",
            "telephone_number": "208-521-4259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 S COOLIDGE ST",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "988371893",
            "telephone_number": "509-765-0674",
            "fax_number": "509-766-8993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "RYAN",
        "middle_name": "D",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-10-15",
        "last_updated": "2009-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moses Lake, WA

Sources for this page

Verify at the official NPI Registry.