Individual provider Active NPI

Cory Louise Ryan, P.A.-C.

  • Physician Assistant
  • Ypsilanti, MI
National Provider Identifier
1962446930
Registry record updated Aug 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601004797 Issued in MI
Practice address
5333 McAuley Dr RM 3111
Ypsilanti, MI 48197-1098
Phone
(734) 712-7688
Fax
(734) 712-7056
NPI assigned
Jun 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 5601004797 MI
Physician Assistant 363A00000X 5601004797 MI Primary

Addresses

Primary practice location

5333 McAuley Dr RM 3111
Ypsilanti, MI 48197-1098

Mailing address

24 Frank Lloyd Wright Dr Lbby J2000
Ann Arbor, MI 48105-9484
Phone (734) 747-6766

Other identifiers 1

IdentifierTypeStateIssuer
5601004797OtherMISTATE LICENSE NUMER

Other names 1

  • Cory Louise Cameron Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060720000306 MI Practitioner - Physician Assistant 3971516741 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Iha Health Services CorporationGroup PAC ID 2466351440, 1,149 clinicians

Practice addresses (Care Compare)

2305 Genoa Bus Park Dr
Brighton, MI 48114-7005

44428 Woodward Ave
Suite 102
Pontiac, MI 48341-5009
Phone (734) 712-8700

51341 W Huron River Dr
Trinity Health Iha Medical Group Primary Ca
Van Buren Township, MI 48111-2571
Phone (734) 997-0304

5301 E Huron River Dr
Ypsilanti, MI 48197-1051

5301 McAuley Dr
Ypsilanti, MI 48197-1051

7575 Grand River Rd
Brighton, MI 48114-9309
Phone (734) 712-7255

775 S Main St
Chelsea, MI 48118-1383

Hospital & facility affiliations

  • Trinity Health Ann Arbor Hospital Hospital, Ann Arbor, MI, CCN 230156
  • Trinity Health Livingston Hospital Hospital, Howell, MI, CCN 230069
  • Chelsea Hospital Hospital, Chelsea, MI, CCN 230259

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Iha Health Service Corporation CurrentSince Apr 1, 2020 Accepting new patients
Iha Health Services Corporation CurrentSince Apr 1, 2020 Accepting new patients

Locations

24 Frank Lloyd Wright Dr
Ann Arbor, MI 48105
Phone (734) 930-7400

2305 Genoa Business Park Dr
Ste 200
Brighton, MI 48114
Phone (810) 494-6840

14650 E Old US Highway 12
Ste 302
Chelsea, MI 48118
Phone (248) 450-2020

128 Van Buren St
Chelsea, MI 48118
Phone (734) 475-8677

10020 Professional Centre Dr
Ste 120
Hamburg Twp, MI 48189
Phone (810) 231-0252

820 Byron Rd
Ste 200
Howell, MI 48843
Phone (517) 548-1246

620 Byron Rd
Howell, MI 48843
Phone (517) 545-5450

44428 Woodward Ave
Ste 102
Pontiac, MI 48341
Phone (734) 712-8700

5333 McAuley Dr
Rm 3111
Ypsilanti, MI 48197
Phone (734) 712-7688

5301 McAuley Dr
Ypsilanti, MI 48197
Phone (734) 712-7246

5333 McAuley Dr
Rm 4001
Ypsilanti, MI 48197
Phone (734) 712-3376

Interoperability endpoints

  • Direct secure messaging: cryan36738@direct.trinity-health.org

Organizations & group practices 3

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 3

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

NPI Registry JSON

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628467200000",
    "number": "1962446930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 FRANK LLOYD WRIGHT DR LBBY J2000",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481059484",
            "telephone_number": "734-747-6766",
            "fax_number": "734-222-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5333 MCAULEY DR RM 3111",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481971098",
            "telephone_number": "734-712-7688",
            "fax_number": "734-712-7056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYAN",
        "first_name": "CORY",
        "middle_name": "LOUISE",
        "credential": "P.A.-C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-16",
        "last_updated": "2021-08-09",
        "certification_date": "2021-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "5601004797",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601004797",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMER",
            "identifier": "5601004797",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CORY",
            "last_name": "CAMERON",
            "middle_name": "LOUISE",
            "credential": "P.A.-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Ypsilanti, MI

Sources for this page

Verify at the official NPI Registry.