Look up the most recent NPI and PECOS records

Ryan Aziz Thomas Bricknell

Internal Medicine

Allopathic & Osteopathic Physicians

200 E Chestnut St Bldg Suite303, Louisville, KY 40202-1831

PECOS Enrollment

This provider is enrolled in PECOS as RYAN BRICKNELL.

Based on the most recent information from CMS, provider Ryan Aziz Thomas Bricknell is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1003470469
Provider Type
Individual
Full Name
Bricknell, Ryan Aziz Thomas
Title
Dr.
Credential
MD

Gender
Male
Sole Proprietor
No
Enumeration Date
4/30/2019
Last Updated
3/30/2023

Contact Information

Practice Location

200 E Chestnut St Bldg Suite303, Louisville, KY 40202-1831

(502) 629-5552

(502) 629-3132

Mailing Location

PO Box 776351, Chicago, IL 60677-6351

(502) 588-9490

(502) 272-5116

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License 56599 Kentucky
Code 390200000X	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License Unlisted Issuer

Provider Identifiers

ID	Description	Issuer
ID 7100881830	Description Medicaid	Issuer Unlisted Kentucky
ID 56599	Description Other	Issuer STATE LICENSE Kentucky

Ryan Aziz Thomas Bricknell

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

Davis, Paul

Paradowski, Brian Joseph

Alwakeedi, Adel Mohammed

Gorr, Haeshik

Carter, Keith Baxter

Quisenberry, Thomas Eric

Cogent Healthcare Of Kentucky, Psc

Chadalapaka, Naga

University Medical Associates

Parikh, Ishan