Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Paul Ryan Lane, PA-C

Individual provider Physician Assistant · NPI 1962023820

Paul Ryan Lane, PA-C is a Physician Assistant in Mount Vernon, Illinois. Qualified in 2020, 6 years ago. Practices with Deaconess Illinois Crossroads Inc, a 7-clinician group and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
6
Licensed in
IL
In the registry since
2020
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

4101 N Water Tower Pl
Mount Vernon, IL 62864-6296
Phone: (618) 244-6222
Fax: (618) 246-1247
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 085.007905 (IL)

Record details

NPI number1962023820
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorYes
NPI enumeratedMay 1, 2020
Last updated in NPPESDecember 18, 2020
Certification dateNovember 7, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Deaconess Illinois Crossroads Inc — 7 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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