Ryan Black, PA-C
Individual provider Active NPI Physician Assistant · Rigby, ID
NPI 1932452091 · NPPES record last updated Oct 24, 2023
Key facts
- NPI
- 1932452091
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- Practice address
- 703 Rigby Lake Dr
Rigby, ID 83442-5192 - Phone
- (208) 745-0200
- Fax
- (208) 745-0212
- NPI assigned
- Oct 25, 2012
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- High Valley Dermatology and Dermatologic Surgery PLLC
Practice addresses (Care Compare)
2085 Providence Way
Idaho Falls, ID 83404-4945
Phone (208) 525-4888
703 Rigby Lake Dr
Rigby, ID 83442-5192
Phone (208) 745-0200
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150123000528 | ID | Practitioner - Physician Assistant | 4486891975 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| High Valley Dermatology & Dermatologic Surgery, PC | Past | Accepting new patients |
Interoperability endpoints
- ryan.black@direct.wyomingmedicalcenter.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | TX | Yes |
Addresses
Primary practice location
703 Rigby Lake Dr
Rigby, ID 83442-5192
Mailing address
703 Rigby Lake Dr
Rigby, ID 83442-5192
Phone (208) 745-0200
Other practice location 1
2085 Providence Way
Idaho Falls, ID 83404-4945
Phone (208) 516-1846
Other providers in Rigby, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 24, 2023. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.