NPIMap

Individual provider Active NPI

Timothy J Ryan, D.O.

  • Internal Medicine Physician
  • Marshall, MO
National Provider Identifier
1790721520
Registry record updated Jun 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
102684 Issued in MO
Practice address
2303 S Highway 65
Marshall, MO 65340-3702
Phone
(660) 886-3364
Fax
(660) 886-6044
NPI assigned
Jun 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 102684 MO Primary

Addresses

Primary practice location

2303 S Highway 65
Marshall, MO 65340-3702

Mailing address

2303 S Highway 65 Ste a
Marshall, MO 65340-3735
Phone (660) 886-3364

Other identifiers 1

IdentifierTypeStateIssuer
246948509MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address TIMOTHYRYAN@fitzgibbon.cernerdirect.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100805000949 MO Practitioner - Internal Medicine 4587767645 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
John Fitzgibbon Memorial Hospital IncGroup PAC ID 2567351570, shared by 12 NPIs, 45 clinicians

Practice addresses (Care Compare)

2305 S Hwy 65
Marshall Sugical Associates
Marshall, MO 65340-3702
Phone (660) 886-6692

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
John Fitzgibbon Memorial Hospital, Inc. Current Accepting new patients
John Fitzgibbon Memorial Hospital Inc CurrentSince Jun 10, 2024 Accepting new patients
John Fitzgibbon Memorial Hospital Inc Current Accepting new patients
John Fitzgibbon Memorial Hospital Inc Internal Medicine CurrentSince Jul 29, 2023 Accepting new patients
John Fitzgibbon Memorial Hospital Inc. CurrentSince Jul 29, 2023 Accepting new patients

Locations

2305 S Highway 65
Marshall, MO 65340
Phone (660) 831-3730

1825 Atchison Ave
Marshall, MO 65340
Phone (660) 886-3434

2303 S Highway 65
Ste A
Marshall, MO 65340
Phone (660) 831-1175

Interoperability endpoints

  • Direct secure messaging: timothyryan@fitzgibbon.cernerdirect.com

Organizations & group practices 6

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 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717718400000",
    "number": "1790721520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2303 S HIGHWAY 65 STE A",
            "city": "MARSHALL",
            "state": "MO",
            "postal_code": "653403735",
            "telephone_number": "660-886-3364",
            "fax_number": "660-886-6044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2303 S HIGHWAY 65",
            "city": "MARSHALL",
            "state": "MO",
            "postal_code": "653403702",
            "telephone_number": "660-886-3364",
            "fax_number": "660-886-6044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYAN",
        "first_name": "TIMOTHY",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-21",
        "last_updated": "2024-06-07",
        "certification_date": "2024-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "102684",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "246948509",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "TIMOTHYRYAN@fitzgibbon.cernerdirect.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2303 S Highway 65",
            "city": "Marshall",
            "state": "MO",
            "country_code": "US",
            "postal_code": "653403702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Marshall, MO

Sources for this page

Verify at the official NPI Registry.