NPIMap

Individual provider Active NPI

Meredith Cooper Ryan

  • Physician Assistant
  • Missoula, MT
National Provider Identifier
1992352892
Registry record updated Apr 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MED-PAC-LIC-104453 Issued in MT
Practice address
601 W Spruce St Ste a
Missoula, MT 59802-4047
Phone
(406) 728-3111
Fax
(406) 728-3116
NPI assigned
Aug 25, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X MED-PAC-LIC-104453 MT Primary

Addresses

Primary practice location

601 W Spruce St Ste a
Missoula, MT 59802-4047

Mailing address

PO Box 12
Liberty Lake, WA 99019-0012
Phone (406) 728-3111

Other practice location 1

2450 SW Perkins Ave
Pendleton, OR 97801-4302
Phone (541) 276-1700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, MT2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20191126001408 OR Practitioner - Physician Assistant 8426481896 Reassigns benefits to 1 organization
I20220117000552 MT Practitioner - Physician Assistant 8426481896 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Health and Services MtGroup PAC ID 6608786306, 358 clinicians

Practice addresses (Care Compare)

500 W Broadway St
Missoula, MT 59802-4003

601 W Spruce St
Missoula, MT 59802-4047

Hospital & facility affiliations

  • Partners in Home Care Inc Home health agency, Missoula, MT, CCN 277032
  • St. Patrick Hospital Hospital, Missoula, MT, CCN 270014
  • Community Medical Center Hospital, Missoula, MT, CCN 270023
  • Providence St Joseph Medical Center Hospital, Polson, MT, CCN 271343

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MED-PAC-LIC-104453MTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Praxis Health, PC CurrentSince Oct 1, 2019 Accepting new patients
Praxis Health, PC CurrentSince Oct 1, 2019 Accepting new patients
Providence Health & Services Mt CurrentSince Mar 11, 2022 Accepting new patients
Providence Health & Services Mt CurrentSince Mar 11, 2022 Accepting new patients
Providence Health & Services Mt Past Accepting new patients

Locations

601 W Spruce St
Ste A
Missoula, MT 59802
Phone (406) 329-2945

500 W Broadway St
Ste 320
Missoula, MT 59802
Phone (406) 329-2945

2450 SW Perkins Ave
Pendleton, OR 97801
Phone (541) 276-1700

Interoperability endpoints

  • Direct secure messaging: mdahle1036436@wm.providencedirect.org

Organizations & group practices 6

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 7

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": "1566691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681344000000",
    "number": "1992352892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990190012",
            "telephone_number": "406-728-3111",
            "fax_number": "406-728-3116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 W SPRUCE ST STE A",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024047",
            "telephone_number": "406-728-3111",
            "fax_number": "406-728-3116"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2450 SW Perkins Ave",
            "address_purpose": "LOCATION",
            "city": "Pendleton",
            "state": "OR",
            "postal_code": "978014302",
            "country_code": "US",
            "telephone_number": "541-276-1700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RYAN",
        "first_name": "MEREDITH",
        "middle_name": "COOPER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-25",
        "last_updated": "2023-04-13",
        "certification_date": "2023-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MT",
            "license": "MED-PAC-LIC-104453",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.