Active NPI
Ryan Buckley, D.O.
- Emergency Medicine Physician
- Johnson City, TN
National Provider Identifier
1861713521
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 4928
- Practice address
- Lamont Street and Veterans Way
Johnson City, TN 37604 - Phone
- (423) 926-1171
- NPI assigned
- Jun 17, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Emergency Medicine Physician | 207P00000X | 4928 | TN | Primary |
Addresses
Primary practice location
Lamont Street and Veterans Way
Johnson City, TN 37604
Mailing address
123 Lake Harbor Dr
Johnson City, TN 37615-2972
Phone (269) 369-0304
Other practice location 1
Bldg H 2005 Knight Lane
Navy Medicine Support Command, ATTN: Medical Staff Serv
jacksonville, FL 32212-0140
Phone (619) 532-6400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4928 | TN | MD | Emergency Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1276732800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1716508800000",
"number": "1861713521",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "123 LAKE HARBOR DR",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376152972",
"telephone_number": "269-369-0304"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "LAMONT STREET AND VETERANS WAY",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "37604",
"telephone_number": "423-926-1171"
}
],
"practiceLocations": [
{
"address_1": "Bldg H 2005 Knight Lane",
"address_2": "Navy Medicine Support Command, ATTN: Medical Staff Serv",
"address_purpose": "LOCATION",
"city": "jacksonville",
"state": "FL",
"postal_code": "322120140",
"country_code": "US",
"telephone_number": "619-532-6400",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BUCKLEY",
"first_name": "RYAN",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-06-17",
"last_updated": "2024-05-24",
"certification_date": "2024-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "TN",
"license": "4928",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Johnson City, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.