Ryan Mark Proctor, D.O.

Primary specialty

Procedural Dermatology PhysicianTaxonomy code 207NS0135X

License

006043 Issued in AZ

Practice address

3015 Hway 95
Suite 110
Bullhead City, AZ 86442-4334

Phone

(928) 758-8885

Fax

(928) 758-2424

NPI assigned

Apr 23, 2012

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 AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Arizona Desert Dermatology and Surgery PCGroup PAC ID 6305732512, 11 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

81.16 of 100Reported as individual

Quality

65.74

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

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.

• Arizona Desert Dermatology and Surgery PC

  • Dermatology Physician
  • Kingman, AZ
  • NPI 1386702546
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1335139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394582400000",
    "number": "1972861326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3015 HWAY 95",
            "address_2": "SUITE 110",
            "city": "BULLHEAD CITY",
            "state": "AZ",
            "postal_code": "864424334",
            "telephone_number": "928-758-8885",
            "fax_number": "928-758-2424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3015 HWAY 95",
            "address_2": "SUITE 110",
            "city": "BULLHEAD CITY",
            "state": "AZ",
            "postal_code": "864424334",
            "telephone_number": "928-758-8885",
            "fax_number": "928-758-2424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROCTOR",
        "first_name": "RYAN",
        "middle_name": "MARK",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-23",
        "last_updated": "2014-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "AZ",
            "license": "006043",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Derek Patrick Price, D.C.
• Tyler Primavera, D.O.
• Pro Imagining Az LLC
• Christopher Alan Proctor, CNS, CRNFA
• Michael Ray Proctor, DO
• Promptcare PC
• Pulmonology Group LLC
• Terry M Puryear
• Zhijia Jack Qiu, D.C.
• Malik Tariq Rahim, M.D.

• Procedural Dermatology Physician in Bullhead City, AZ
• Providers in Bullhead City, AZ by specialty
• Procedural Dermatology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2014; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.