DR. KELLY W RYDER D.O.
NPI 1083866651
Internal Medicine in Hattiesburg, MS
About Dr. Kelly W Ryder D.o. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. KELLY W RYDER D.O. (NPI 1083866651) is an individual internal medicine provider in Hattiesburg, Mississippi, licensed in Mississippi (22127) and active in the NPI registry since October 2008. He is enrolled in Medicare PECOS, is affiliated with Gallup Indian Medical Center, and is a graduate of Other (2005).
NPPES Registry Identity
Specialties & Licenses 2
Other Identifiers 5
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Dr. Kelly W Ryder D.o. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignments
6Medicare enrollment records show Kelly Ryder reassigns Medicare billing to 6 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Oak Ridge, TN 37830
- Reassigned Medicare billing, Tennessee enrollment
- 1,085 clinicians in this Medicare group
Johnson City, TN 37615
- Reassigned Medicare billing, Tennessee enrollment
- 357 clinicians in this Medicare group
Martin, SD 57551
- Reassigned Medicare billing, Texas enrollment
- 426 clinicians in this Medicare group
Cheyenne, WY 82001
- Reassigned Medicare billing, Wyoming enrollment
- 70 clinicians in this Medicare group
Gallup, NM 87301
- Reassigned Medicare billing, Texas enrollment
- 618 clinicians in this Medicare group
Lander, WY 82520
- Reassigned Medicare billing, Wyoming enrollment
- 66 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Areas of Expertise CMS Part B claims 2
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Hospital Affiliations CMS Care Compare 2
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Gallup Indian Medical Center
Acute Care Hospitals · Gallup, NMPine Ridge Ihs Hospital
Acute Care Hospitals · Pine Ridge, SDPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 39401 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Referred Medical Equipment & Supplies CMS DME claims 2
Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Kelly Ryder's NPI number?
The NPI number for Kelly Ryder is 1083866651. It was assigned to this individual provider in the NPPES registry on October 15, 2008.
Where is Kelly Ryder located?
Kelly Ryder practices at 415 S 28th Ave, Hattiesburg, MS 39401. The listed phone number is (601) 288-4329.
What is Kelly Ryder's specialty?
The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.
Is Kelly Ryder enrolled in Medicare?
Yes. Kelly Ryder is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organizations bill Medicare for Kelly Ryder's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Kelly Ryder reassigns Medicare benefits to 6 organizations: Southeastern Physician Services PC (Oak Ridge, TN), State Of Franklin Healthcare Associates PLLC (Johnson City, TN), Pine Ridge Indian Health Service Hospital (Martin, SD), Summit Hospitalist Group LLC (Cheyenne, WY), Dhhs,phs,naihs,gallup Indian Medical Center (Gallup, NM) and 1 more organization, listed in the Medicare section above. Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kelly Ryder's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
Is Kelly Ryder affiliated with any hospitals?
According to CMS data, Kelly Ryder is affiliated with Gallup Indian Medical Center and Pine Ridge Ihs Hospital.
When was this NPI record last updated?
The NPPES record for Kelly Ryder was last updated on July 11, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Dr. Kelly W Ryder, D.O. · NPI 1083866651
Internal Medicine physician in Hattiesburg, Mississippi. Individual provider, active in the CMS NPPES registry since October 15, 2008.
## Identity
- **NPI:** 1083866651 (Entity type: Individual)
- **Enumerated:** October 15, 2008
- **Primary specialty:** Internal Medicine · taxonomy 207R00000X
- **State license:** 22127 (Mississippi)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 415 S 28TH AVE, Hattiesburg, MS 39401-7246
- **Phone:** (601) 288-4329
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 6 organizations under Medicare reassignment (form CMS-855R): Southeastern Physician Services PC (NPI 1083835441, Oak Ridge, TN); State Of Franklin Healthcare Associates PLLC (NPI 1063459410, Johnson City, TN); Pine Ridge Indian Health Service Hospital (NPI 1003208257, Martin, SD); Summit Hospitalist Group LLC (NPI 1356985600, Cheyenne, WY); Dhhs,phs,naihs,gallup Indian Medical Center (NPI 1245409960, Gallup, NM); and 1 more · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2005
## Record status
- **NPPES last updated:** July 11, 2019
- **Other identifiers:** Other 3226035 (MS); Other 6576308 (MS); Other P01109812 (MS); and 2 more
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Source: [NPI Profile](https://npiprofile.com/npi/1083866651) · Data from the CMS NPPES public registry.