Individual provider Active NPI

Joo Yeon Ryu

  • Hospitalist Physician
  • Rochester, NY
National Provider Identifier
1891113403
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
020795 Issued in NY
Practice address
601 Elmwood Ave
Rochester, NY 14642-4579
Phone
(585) 275-4912
Fax
(585) 276-2144
NPI assigned
Apr 1, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Hospitalist Physician 208M00000X 020795 NY Primary

Addresses

Primary practice location

601 Elmwood Ave
Rochester, NY 14642-4579

Mailing address

601 Elmwood Ave
Rochester, NY 14642-0001
Phone (585) 275-4912

Other practice location 1

41401 Timber Creek Ter
Fremont, CA 94539-4579
Phone (510) 579-8432

Other practice location 2

41401 Timber Creek Ter
Fremont, CA 94539-4579
Phone (510) 579-8432

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221111001060 WA Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 5799059069

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
290619NYMDLicensed Practical Nurse

NPI Registry JSON

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

{
    "created_epoch": "1396310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1891113403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 ELMWOOD AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146420001",
            "telephone_number": "585-275-4912",
            "fax_number": "585-276-2144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 ELMWOOD AVE",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146424579",
            "telephone_number": "585-275-4912",
            "fax_number": "585-276-2144"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "41401 Timber Creek Ter",
            "address_purpose": "LOCATION",
            "city": "Fremont",
            "state": "CA",
            "postal_code": "945394579",
            "country_code": "US",
            "telephone_number": "510-579-8432",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "41401 Timber Creek Ter",
            "address_purpose": "LOCATION",
            "city": "Fremont",
            "state": "CA",
            "postal_code": "945394579",
            "country_code": "US",
            "telephone_number": "510-579-8432",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RYU",
        "first_name": "JOO YEON",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-01",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NY",
            "license": "020795",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, NY

Sources for this page

Verify at the official NPI Registry.