Ryan Black (NPI# 1932452091, PAC ID# 4486891975) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PHYSICIAN ASSISTANT.
| Nation Provider ID (NPI) | 1932452091 |
| PAC ID by PECOS | 4486891975 |
| Professional Enrollment ID | I20150123000528 |
| Full Name | Ryan Black |
| Organization Legal Name | DERMATOLOGY OF EASTERN IDAHO PA |
| Address |
703 Rigby Lake Dr Rigby ID 83442-5192 |
| Phone Number | 2087450200 |
| Gender | M |
| Graduation Year | 2012 |
| Primary Specialty | PHYSICIAN ASSISTANT |
| Group Practice PAC ID | 6800930421 |
| Number of Group Practice Members | 2 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 130018 | EASTERN IDAHO REGIONAL MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 703 Rigby Lake Dr, Rigby, ID 83442-5192 | 2087450200 | DERMATOLOGY OF EASTERN IDAHO PA |
| Organization Legal Name | DERMATOLOGY OF EASTERN IDAHO PA |
| Physicians | 2 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Kay Bishop | Dermatology | Dermatology of Eastern Idaho Pa | 703 Rigby Lake Dr, Rigby, ID 83442-5192 |
| Street Address |
703 RIGBY LAKE DR |
| City | RIGBY |
| State | ID |
| Zip | 83442-5192 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Kay Bishop | Dermatology | Dermatology of Eastern Idaho Pa | 703 Rigby Lake Dr, Rigby, ID 83442-5192 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Dwight R Hansen | Optometry | 225 W Main St, Rigby, ID 83442-1351 | |
| Patricia Stadler | Nurse Practitioner | Mountain View Hospital LLC | 167 E 1st, Rigby, ID 83442-1401 |
| Hailey Anne Clark | Nurse Practitioner | Mountain View Hospital LLC | 167 E 1st, Rigby, ID 83442-1401 |
| Tracy E Mobley | Physical Therapy | Mobley Physical Therapy PC | 151 E Main St, Rigby, ID 83442-1417 |
| Carl A Johnson | Physical Therapy | Mobley Physical Therapy PC | 151 E Main St, Rigby, ID 83442-1417 |
| Mitch L Jephson | Chiropractic | 119 N State St, Suite 2, Rigby, ID 83442-1423 | |
| Kurt E Kracaw | Family Practice | 426 Farnsworth Way, Suite 1, Rigby, ID 83442-4713 | |
| Brent Clayson | Qualified Audiologist | 527 Rigby Lake Dr, Suite C, Rigby, ID 83442-5117 | |
| Adam R Blakeman | Physician Assistant | Upper Valley Family Medicine Pllc | 711 Rigby Lake Dr, Suite 115, Rigby, ID 83442-5230 |
| William D Adams | Family Medicine | Upper Valley Family Medicine Pllc | 711 Rigby Lake Dr, Suite 115, Rigby, ID 83442-5230 |
| Find all physicians in zip 83442 | |||
| City | RIGBY |
| Zip Code | 83442 |
| Specialty | PHYSICIAN ASSISTANT |
| City + Specialty | RIGBY + PHYSICIAN ASSISTANT |
Please comment or provide details below to improve the information on Ryan Black.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.