Provider Demographics
NPI:1205928181
Name:BAUMERT, RYAN J (PA-C)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:J
Last Name:BAUMERT
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:6900 A ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4120
Mailing Address - Country:US
Mailing Address - Phone:402-436-2000
Mailing Address - Fax:402-434-2691
Practice Address - Street 1:6900 A ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4120
Practice Address - Country:US
Practice Address - Phone:402-436-2000
Practice Address - Fax:402-434-2691
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE990363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE280585Medicare PIN
NEQ73323Medicare UPIN