Ryan J Thordal, D.O.
Individual provider Active NPI General Practice Physician · McConnell Afb, KS
NPI 1871848846 · NPPES record last updated Apr 12, 2018
Key facts
- NPI
- 1871848846
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- 57333 (MN)
- Practice address
- 57950 Leavenworth St
McConnell Afb, KS 67221-3506 - Phone
- (316) 759-5116
- NPI assigned
- Jul 17, 2012
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in NY, NJ, KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241206001897 | NY | Practitioner - General Practice | 5799119236 | Reassigns benefits to 2 organizations |
| I20250707000689 | NJ | Practitioner - Internal Medicine | 5799119236 | Reassigns benefits to 1 organization |
| I20250728001638 | KY | Practitioner - Emergency Medicine | 5799119236 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 253114 | MA | MD | Internal Medicine Physician |
| 57333 | MN | MD | General Practice Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Upstate Ny Physician PLLC | Current |
Accepting new patients | |
| Small Hospital Innovations LLC | Current |
Accepting new patients | |
| Wajeeh Sana Physician PC | Internal Medicine | Current |
Accepting new patients |
| Green Valley Emergency Physicians, LLC | Current |
Accepting new patients |
Locations
81 Ball Park Rd
Harlan, KY 40831
Phone (606) 573-8100
130 Kate Ireland Dr
Hyden, KY 41749
Phone (606) 672-2341
11203 Main St
Martin, KY 41649
Phone (606) 285-5181
3600 Cumberland Ave
Middlesboro, KY 40965
Phone (606) 237-1700
1530 Lone Oak Rd
Paducah, KY 42003
Phone (270) 444-2444
5000 Ky Route 321
Prestonsburg, KY 41653
Phone (606) 886-7645
240 Hospital Rd
Whitesburg, KY 41858
Phone (606) 633-3500
111 Central Ave
Newark, NJ 07102
Phone (973) 877-5060
427 Guy Park Ave
Amsterdam, NY 12010
Phone (518) 442-1404
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 253114 | MA | |
| General Practice Physician | 208D00000X | 57333 | MN | Yes |
Addresses
Primary practice location
57950 Leavenworth St
McConnell Afb, KS 67221-3506
Mailing address
324 N Emporia Ave Apt 321
Wichita, KS 67202-2548
Phone (218) 415-1462
Other providers in McConnell Afb, KS
- Lee D Shibley
- James Daniel Sigler
- Charissa Marie Slater
- Maddison Smith
- Jonathan David Taylor
- Diane Todd
- Mark Truxillo
- Jarron Robert Turnbull
- Jennifer Lynn Varney
- Norma Alicia Villarreal
All providers in McConnell Afb, KS · General Practice Physician in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 12, 2018. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.