Ryan Black, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA63384 Issued in CA

Practice address

802 Magnolia Ave Ste 205
Corona, CA 92879-3144

Phone

(951) 281-2730

NPI assigned

Oct 23, 2023

Last updated

Oct 30, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: ryan.black.1@3408.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Grace Family Health, Inc.

  dba Murrieta Express Care

  • Primary Care Clinic/Center
  • Murrieta, CA
  • NPI 1033426028
  Medicare reassignment
• Murrieta Express Care, Inc

  • Urgent Care Clinic/Center
  • Murrieta, CA
  • NPI 1891528592
  NPD (past)

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

{
    "created_epoch": "1698019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730246400000",
    "number": "1972375079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40335 WINCHESTER RD",
            "address_2": "SUITE E #238",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "92591",
            "telephone_number": "760-420-4123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 MAGNOLIA AVE STE 205",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928793144",
            "telephone_number": "951-281-2730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "RYAN",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-10-23",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA63384",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bin H. Park D.D.S. Inc.
• Alex Patri Birren, D.C.
• Sylvia Bishop
• Bitthal Das Maheshwari MD Prof Corp (Bithhal D Maheshwari M.D. Prof Corp.)
• Jamie Black, NP
• Erin Blackwell
• Samantha Blair
• Teia Blanchette
• Sarena Blanco
• Kamila Blas

• Medical Physician Assistant in Corona, CA
• Providers in Corona, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.