DR. RENEE ANNE RYAN (NPI# 1386811545) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386811545 |
| Entity Type | Individual |
| Full Name | DR. RENEE ANNE RYAN |
| Credential | M.D. |
| Practice Address |
4103 Medical Center Dr Fayetteville NY 13066-6600 |
| Practice Telephone | 3156377800 |
| Practice Fax Number | 3156377808 |
| Mailing Telephone | 3156377800 |
| Mailing Fax Number | 3156377808 |
| Enumeration Date | 2008-05-15 |
| Last Update Date | 2012-02-20 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207P00000X | Emergency Medicine | 248246 | NY | Allopathic & Osteopathic Physicians |
| Y | 207Q00000X | Family Medicine | 248246-1 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | BLUE SHIELD | 204500162 | 01 |
| NY | 03027323 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629545686 | Renee Ryan | Assistant Behavior Analyst | 5601 Arnold Rd Fl 102, Dublin, CA 94568-7726 | 2018-10-29 |
| 1528057932 | Renee G Ryan | Physician Assistant | 515 Hospital Dr, Suite 1, Shelbyville, KY 40065-1619 | 2005-10-18 |
| Street Address |
4103 MEDICAL CENTER DR |
| City | FAYETTEVILLE |
| State | NY |
| Zip Code | 13066-6600 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396748414 | Andrew L Finley | Emergency Medicine | 4103 Medical Center Dr, Fayetteville, NY 13066-6600 | 2005-05-23 |
| 1689191736 | Emily M Marris | Physician Assistant | 4103 Medical Center Dr, Fayetteville, NY 13066-6600 | 2017-08-29 |
| 1225397805 | Sarah Kathryn Leo | Registered Nurse | 4103 Medical Center Dr, Fayetteville, NY 13066-6600 | 2012-05-16 |
| 1902134216 | Hannah Lovallo | Physician Assistant | 4103 Medical Center Dr, Fayetteville, NY 13066-6600 | 2009-11-24 |
| 1487852851 | Mark A Profetto | Nurse Practitioner | 4103 Medical Center Dr, Fayetteville, NY 13066-6600 | 2007-07-06 |
| 1790819126 | Anita D O'malley | Physician Assistant | 4103 Medical Center Dr, Fayetteville, NY 13066-6600 | 2007-03-15 |
| 1144367749 | Nerissa Ann Jackson | Physician Assistant | 4103 Medical Center Dr, Fayetteville, NY 13066-6600 | 2007-01-31 |
| 1841206356 | Linda M Goff | Nurse Practitioner | 4103 Medical Center Dr, Fayetteville, NY 13066-6600 | 2006-08-01 |
| 1215990536 | Stephen J Jackowski | Physician Assistant | 4103 Medical Center Dr, Fayetteville, NY 13066-6600 | 2006-04-08 |
| 1740283829 | Audrey A Mathis | Registered Nurse | 4103 Medical Center Dr, Fayetteville, NY 13066-6600 | 2005-05-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457819963 | Word Wellness Center, LLC | Psychologist | 6836 E Genesee Street, Suite A, Fayetteville, NY 13066 | 2019-03-05 |
| 1629529060 | Lorna Boyer Chase | Marriage & Family Therapist | 109 White Heron Circle, Fayetteville, NY 13066 | 2016-10-20 |
| 1699221432 | Roman Batyuk | Nurse Practitioner | 4100 Medical Center Drive, Fayetteville, NY 13066 | 2016-08-31 |
| 1427405133 | National Eye Care, Inc | Optometrist | 5160 Kinloch Circle, Fayetteville, NY 13066 | 2016-05-23 |
| 1013375328 | Kristin Kukenberger | Chiropractor | 7000 E Genesee St Bldg B, Fayetteville, NY 13066 | 2016-02-01 |
| 1124394671 | Susan Hartman Brenizer | Marriage & Family Therapist | 7000 E Genesee St Lyndon Office Park, Bldg. A, Second Floor (upper Level), Fayetteville, NY 13066 | 2012-03-29 |
| 1245541432 | Rene L Converse | Occupational Therapist | 7200 E. Genesee Street, Fayetteville, NY 13066 | 2010-06-23 |
| 1689815805 | Menorah Park Group Residents | Clinic/Center | 12 Jamar Drive, Dewitt, NY 13066 | 2009-03-18 |
| 1063677458 | John Marcena Glezen | Obstetrics & Gynecology | 1 The Gazebo, Fayetteville, NY 13066 | 2008-07-24 |
| 1629232418 | Tucker Martin Harris | Otolaryngology | 4000 Medical Center Dr # 117, Fayetteville, NY 13066 | 2008-07-11 |
| Find all providers in zip 13066 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376169185 | Raheem Lalani | Family Medicine | 230 Fieldstone Way, Fayetteville, GA 30215-8170 | 2020-06-18 |
| 1821619370 | Kelly R. Mccarty | Family Medicine | 5872 W Bannister Dr, Fayetteville, AR 72704-6536 | 2020-05-06 |
| 1720620230 | Vector Health and Wellness, LLC | Family Medicine | 1267 N Steamboat Dr Ste 3, Fayetteville, AR 72704-7148 | 2019-10-16 |
| 1295382182 | Nimota Motunrayo Akintoye | Family Medicine | 140 Briergate Pl, Fayetteville, GA 30214-3931 | 2019-08-24 |
| 1609332725 | Fastmed Health Nc, Pllc | Family Medicine | 150 Francam Dr, Fayetteville, NC 28311-4500 | 2019-02-13 |
| 1013486638 | K E Management Services | Family Medicine | 1420 E Augustine Ln Ste 7, Fayetteville, AR 72703-4995 | 2018-11-14 |
| 1659896751 | Melissa Holt | Family Medicine | 108 Medical Center Blvd Ste G-50, Fayetteville, TN 37334-2741 | 2017-08-09 |
| 1124477484 | Mark William Guelzow | Family Medicine | 4101 Medical Center Dr Ste 1c, Fayetteville, NY 13066-6600 | 2016-06-08 |
| 1962865659 | Tracie Fullove | Family Medicine | 3162 W Martin Luther King Blvd Ste 13-14, Fayetteville, AR 72704-7679 | 2016-03-31 |
| 1053778936 | Linda Nancy Robinson | Family Medicine | 7107 Thorntree Hill Dr, Fayetteville, NY 13066-9790 | 2016-01-22 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 13066 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.