RYAN T MCCULLOCH (PA) – Physician Assistant, NPI 1720195530
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,534 PHYSICIAN ASSISTANT in ID
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Provider Addresses for RYAN T MCCULLOCH (PA)
147, West Chubbuck Road, Chubbuck, Bannock County, Idaho, 83202, United States
CHUBBUCK, ID 832022314
Phone: (208) 238-7546
Fax: (208) 237-9643
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 119 Open Payments records for all available years, with a total value of $1,761.
Total Amount is formed as General ($1,761) + Research ($0) + Ownership ($0) = $1,761.
Last reported payment date: 2024-12-17 • Largest payer in this snapshot: Novartis Pharmaceuticals Corporation ($450).
Total Amount
$1,761
General + Research + Ownership
Payments
119
Total payment records
General Amount
$1,761
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-17
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Novartis Pharmaceuticals Corporation | $450 |
| ABBVIE INC. | $411 |
| Janssen Biotech, Inc. | $164 |
| Regeneron Healthcare Solutions, Inc. | $139 |
| LEO Pharma Inc. | $97 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2004-06-22
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20040622001520 | I | Physician Assistant | ID | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| J7345 | Aminolevulinic acid hcl for topical administration, 10% gel, 10 mg | 2,800 | 14 | $0 |
| 17003 | Destruction of precancer skin growth, 2-14 growths | 2,469 | 457 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 1,074 | 825 | $0 |
| 17000 | Destruction of precancer skin growth, 1 growth | 737 | 585 | $0 |
| 11102 | Biopsy of related skin growth, first growth | 271 | 253 | $0 |
Insurance plans in this area (ZIP 83202)
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Provider's Procedures
Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | NV | |
| Physician Assistant | ID | |
| Micrographic Dermatologic Surgery (Mds), Dermatology | ID | |
| D E R M A T O L O G Y | WA | |
| Micrographic Dermatologic Surgery (Mds) | ID | |
| Physician Assistant | ID |
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