Ryan T Mcculloch (NPI# 1720195530, PAC ID# 5991780082) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PHYSICIAN ASSISTANT.
| Nation Provider ID (NPI) | 1720195530 |
| PAC ID by PECOS | 5991780082 |
| Professional Enrollment ID | I20040622001520 |
| Full Name | Ryan T Mcculloch |
| Organization Legal Name | STODDARD MEDICAL INC |
| Address |
147 W Chubbuck Rd Chubbuck ID 83202-2314 |
| Phone Number | 2082387546 |
| Gender | M |
| Credential | PA |
| Medical School | UNIVERSITY OF NEBRASKA COLLEGE OF MEDICINE |
| Graduation Year | 2002 |
| Primary Specialty | PHYSICIAN ASSISTANT |
| Group Practice PAC ID | 0840341517 |
| Number of Group Practice Members | 5 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 130028 | PORTNEUF MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 147 W Chubbuck Rd, Chubbuck, ID 83202-2314 | 2082387546 | STODDARD MEDICAL INC |
| Measure Identifier | Measure Title | Performance Rate | Reporting Mechanism |
|---|---|---|---|
| ACI_EC_TRANS_PHCDRR_3 | Specialized Registry Reporting | % | |
| ACI_EC_TRANS_PPHI_1 | Security Risk Analysis | % | |
| MIPS_EC_137_overall | Melanoma: Continuity of Care - Recall System | 100% | |
| MIPS_EC_224_overall | Melanoma: Overutilization of Imaging Studies in Melanoma | 100% | |
| MIPS_EC_238_2+ | Use of High-Risk Medications in the Elderly (100%: worst, 0% best) | 0% | |
| MIPS_EC_238_overall | Use of High-Risk Medications in the Elderly (100%: worst, 0% best) | 0% | |
| MIPS_EC_337_overall | Tuberculosis (TB) Prevention for Psoriasis, Psoriatic Arthritis and Rheumatoid Arthritis Patients on a Biological Immune Response Modifier | 70% | |
| MIPS_EC_402_overall | Tobacco Use and Help with Quitting Among Adolescents | 95% |
| Organization Legal Name | STODDARD MEDICAL INC |
| Physicians | 5 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Trevor Jack Batty | Dermatology | Stoddard Medical Inc | 147 W Chubbuck Rd, Chubbuck, ID 83202-2314 |
| Earl R Stoddard | Dermatology | Stoddard Medical Inc | 147 W Chubbuck Rd, Chubbuck, ID 83202-2314 |
| Leslie I Burnside | Physician Assistant | Stoddard Medical Inc | 147 W Chubbuck Rd, Chubbuck, ID 83202-2314 |
| Amy L Mckinlay | Physician Assistant | Stoddard Medical Inc | 147 W Chubbuck Rd, Chubbuck, ID 83202-2314 |
| Street Address |
147 W CHUBBUCK RD |
| City | CHUBBUCK |
| State | ID |
| Zip | 83202-2314 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Trevor Jack Batty | Dermatology | Stoddard Medical Inc | 147 W Chubbuck Rd, Chubbuck, ID 83202-2314 |
| Earl R Stoddard | Dermatology | Stoddard Medical Inc | 147 W Chubbuck Rd, Chubbuck, ID 83202-2314 |
| Leslie I Burnside | Physician Assistant | Stoddard Medical Inc | 147 W Chubbuck Rd, Chubbuck, ID 83202-2314 |
| Amy L Mckinlay | Physician Assistant | Stoddard Medical Inc | 147 W Chubbuck Rd, Chubbuck, ID 83202-2314 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Scott Bradley Schaffer | Nurse Practitioner | 476 E Chubbuck Rd, Chubbuck, ID 83202-1816 | |
| Brittany Strong | Nurse Practitioner | Need-a-nurse Medical Staffing, LLC | 476 E Chubbuck Rd, Chubbuck, ID 83202-1816 |
| David P Brizzee | Family Medicine | 2010 Flandro Dr, Pocatello, ID 83202-1947 | |
| Nathan J Evans | Chiropractic | 2010 Flandro Dr, Pocatello, ID 83202-1947 | |
| Lavar W Kofoed | Optometry | Lwk, P.C. | 4013 Yellowstone Ave, Suite D, Chubbuck, ID 83202-1984 |
| Richard Dallin Boardman | Optometry | Lwk, P.C. | 4013 Yellowstone Ave, Suite D, Chubbuck, ID 83202-1984 |
| Daniel G Nielson | Optometry | Lwk, P.C. | 4013 Yellowstone Ave, Suite D, Chubbuck, ID 83202-1984 |
| Sandra L Vollmer | Clinical Social Worker | T Help | 4737 S Afton Pl, Suite A, Chubbuck, ID 83202-2317 |
| Daniel L Traughber | Psychologist, Clinical | T Help | 4737 S Afton Pl, Suite A, Chubbuck, ID 83202-2317 |
| Russell L Vollmer | Clinical Social Worker | T Help | 4737 S Afton Pl, Suite A, Chubbuck, ID 83202-2317 |
| Find all physicians in zip 83202 | |||
| City | CHUBBUCK |
| Zip Code | 83202 |
| Specialty | PHYSICIAN ASSISTANT |
| City + Specialty | CHUBBUCK + PHYSICIAN ASSISTANT |
Please comment or provide details below to improve the information on Ryan T Mcculloch.
| 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.