Ryan J Lieske, PA-C
Individual provider Active NPI Physician Assistant · Ravenna, NE
NPI 1821040536 · NPPES record last updated May 5, 2010
Key facts
- NPI
- 1821040536
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 767 (NE)
- Practice address
- 104 W Seneca St
Ravenna, NE 68869-1363 - Phone
- (308) 452-3203
- Fax
- (308) 452-3795
- NPI assigned
- May 17, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 11
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Phelps Memorial Health Center
Practice addresses (Care Compare)
1215 Tibbals St
Holdrege, NE 68949-1255
Phone (308) 995-2211
Hospital & facility affiliations
- Franklin County Memorial Hospital
- Phelps Memorial Health Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NE
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040317000867 | NE | Practitioner - Physician Assistant | 3678463320 | Reassigns benefits to 5 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 767 | KS | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Phelps Memorial Health Center | Current | Accepting new patients | |
| Harlan County Health System | Physician Assistant | Current |
Accepting new patients |
| Phelps Memorial Health Center | Physician Assistant | Current |
Accepting new patients |
| Central Nebraska Cardiology | Past | Accepting new patients | |
| Platte Valley Medical Group, P.C. | Past | Accepting new patients | |
| Mid America Neurosurgery Clinic PC | Past | Accepting new patients |
Locations
717 Brown St
Alma, NE 68920
Phone (308) 928-2151
1215 Tibbals St
Holdrege, NE 68949
Phone (308) 995-2211
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 767 | NE | Yes |
Addresses
Primary practice location
104 W Seneca St
Ravenna, NE 68869-1363
Mailing address
104 W Seneca St
Ravenna, NE 68869-1363
Phone (308) 452-3203
Other providers in Ravenna, NE
- Shaun M Hiemstra
- Jennifer Hoard
- Jake Jarzynka
- Kelley Jarzynka
- Jennifer Elizebeth Khaled
- Toria D McDowell
- Mark McNish
- Joseph Morrow
- Ravenna Medical Clinic PC
- Ravenna Public School
All providers in Ravenna, NE · Physician Assistant in Nebraska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 5, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.