Kaelly Ann Ryan, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

1000 State St
Springfield, MA 01109-3151

Phone

(413) 205-3248

NPI assigned

Jun 28, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kaelly Ann Miller Former name

Medicare fee-for-service enrollment

Enrolled in MA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Riverbend Medical Group, Inc.

  • Internal Medicine Physician
  • Springfield, MA
  • NPI 1841651197
  Medicare reassignment
• Riverbend Medical Group, Inc

  • Durable Medical Equipment & Medical Supplies
  • Springfield, MA
  • NPI 1265023154
  NPD

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

{
    "created_epoch": "1561680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662595200000",
    "number": "1811558943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 STATE ST # 55",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011093151",
            "telephone_number": "443-487-3351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 STATE ST",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011093151",
            "telephone_number": "413-205-3248"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "230 Main St",
            "address_purpose": "LOCATION",
            "city": "Agawam",
            "state": "MA",
            "postal_code": "010011838",
            "country_code": "US",
            "telephone_number": "413-789-6800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RYAN",
        "first_name": "KAELLY",
        "middle_name": "ANN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-28",
        "last_updated": "2022-09-08",
        "certification_date": "2022-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAELLY",
            "last_name": "MILLER",
            "middle_name": "ANN",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kristen Jade Russo, PHARMD
• Victoria Ruvkun, MD
• Justinian B Rweyemamu
• Erika Ryan
• Genevieve Marie Ryan
• Gabriel E Ryb, M.D.
• Gregory Rybacki, DO
• Elizabeth Ryder
• Yvette Stephaine Ryles
• Kelsey M. Rynkiewicz, PHD, LAT, ATC, NREMT

• Physician Assistant in Springfield, MA
• Providers in Springfield, MA by specialty
• Physician Assistant in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.