Individual provider Active NPI

Jaclyn Nicole Ryan

  • Family Nurse Practitioner
  • Buffalo, NY
National Provider Identifier
1841786407
Registry record updated Jul 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
343274 Issued in NY
Practice address
300 Niagara St
Buffalo, NY 14201
Phone
(716) 242-8600
NPI assigned
Jul 7, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 343274 NY Primary

Addresses

Primary practice location

300 Niagara St
Buffalo, NY 14201

Mailing address

155 Lawn Ave
Buffalo, NY 14207-1816
Phone (716) 242-8600

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
I20180817002043 NY Practitioner - Nurse Practitioner 3476802877 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

155 Lawn Ave
Buffalo, NY 14207-1816
Phone (716) 875-2904

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
343274NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Neighborhood Health Center of Wny, Inc. CurrentSince Jul 16, 2018 Accepting new patients
Neighborhood Health Center of Wny, Inc. CurrentSince Jul 16, 2018 Accepting new patients

Locations

155 Lawn Ave
Buffalo, NY 14207
Phone (716) 875-2904

4233 Lake Ave
Buffalo, NY 14219
Phone (716) 332-3070

1569 Niagara St
Buffalo, NY 14213
Phone (716) 427-7000

300 Niagara St
Buffalo, NY 14201
Phone (716) 242-8600

151 Elmview Ave
Hamburg, NY 14075
Phone (716) 648-3040

Interoperability endpoints

  • Direct secure messaging: jaclyn.ryan.1@26491.direct.athenahealth.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1530921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531958400000",
    "number": "1841786407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 LAWN AVE",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142071816",
            "telephone_number": "716-242-8600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 NIAGARA ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "14201",
            "telephone_number": "716-242-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYAN",
        "first_name": "JACLYN",
        "middle_name": "NICOLE",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-07",
        "last_updated": "2018-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "343274",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

Verify at the official NPI Registry.