NPIMap

Individual provider Active NPI

Kellen Ryan, PA

  • Physician Assistant
  • Saratoga Springs, NY
National Provider Identifier
1912729831
Registry record updated Nov 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
032029 Issued in NY
Practice address
211 Church St
Saratoga Springs, NY 12866-1090
Phone
(518) 587-3222
NPI assigned
Oct 30, 2024
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 11, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 032029 NY
Surgical Physician Assistant 363AS0400X 032029 NY
Physician Assistant 363A00000X 032029 NY Primary

Addresses

Primary practice location

211 Church St
Saratoga Springs, NY 12866-1090

Mailing address

3A Lace LN
Clifton Park, NY 12065-3605

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250226001468 NY Practitioner - Physician Assistant 6507386174 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Albany Medical College of Union University, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saratoga HospitalGroup PAC ID 6406740273, 353 clinicians

Practice addresses (Care Compare)

1 W Ave
Suite 300
Saratoga Springs, NY 12866-6050
Phone (518) 693-4699

211 Church St
Saratoga Springs, NY 12866-1003
Phone (518) 583-8421

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
032029NYMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Saratoga Hospital CurrentSince Jan 31, 2025 Accepting new patients
Saratoga Hospital CurrentSince Jan 31, 2025 Accepting new patients
Saratoga Hospital Past Accepting new patients

Locations

211 Church St
Saratoga Springs, NY 12866
Phone (518) 583-8461

1 West Ave
Ste 300
Saratoga Springs, NY 12866
Phone (518) 693-4699

3044 Route 50
Saratoga Springs, NY 12866
Phone (518) 886-5800

Organizations & group practices 4

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.

Hospital & facility affiliations 18

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1730246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731283200000",
    "number": "1912729831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3A LACE LN",
            "city": "CLIFTON PARK",
            "state": "NY",
            "postal_code": "120653605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 CHURCH ST",
            "city": "SARATOGA SPRINGS",
            "state": "NY",
            "postal_code": "128661090",
            "telephone_number": "518-587-3222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYAN",
        "first_name": "KELLEN",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-10-30",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "032029",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NY",
            "license": "032029",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "032029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saratoga Springs, NY

Sources for this page

Verify at the official NPI Registry.