KAELLY ANN RYAN (PA-C) – Physician Assistant, NPI 1811558943
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for KAELLY ANN RYAN (PA-C)
230 Main St
Agawam, MA 010011838
Phone: (413) 789-6800
Type: Location
PO BOX 654
WESTMINSTER, MD 211580654
Phone: (443) 487-3351
Type: Mailing
230, Main Street, Agawam, Hampden County, Massachusetts, 01001, United States
AGAWAM, MA 010011838
Phone: (413) 789-6800
Type: Location
1000 STATE ST # 55
SPRINGFIELD, MA 011093151
Phone: (443) 487-3351
Type: Mailing
1000 STATE ST
SPRINGFIELD, MA 011093151
Phone: (413) 205-3248
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2020-01-22
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 |
|---|---|---|---|---|
| I20200122000570 | I | Physician Assistant | MA | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 01001)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | MA | |
| - | MA | |
| Diagnostic Radiology | MA | |
| - | NY | |
| - | MA | |
| - | MA | |
| - | CT | |
| Physician Assistant | MA | |
| P O D I A T R Y | MA | |
| Physician Assistant | MA |
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