Physician Compare National (NPI:1861575987)

HEALTHCARE PROVIDER: JAMES JOSEPH RYAN MSW LCSW

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1861575987
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4082807748
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101026000955
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	RYAN
	Individual professional last name
Provider First Name	JAMES
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1968
	Individual professional's medical school graduation year
Primary Specialty	CLINICAL SOCIAL WORKER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	6072 BRYNWOOD DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 105
	Group Practice or individual's line 2 address
City	ROCKFORD
	Group Practice or individual's city
State	IL
	Group Practice or individual's state
Zip Code	611145829
	Group Practice or individual's zip code (9 digits when available)
Phone Number	8158476651
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y